- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.00 / $377.85 / $1,018.45
| Facility | | $151.00 | $377.85 | $1,018.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.73 / $131.55 / $204.66
| Professional | | $118.73 | $131.55 | $204.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.70 / $175.61 / $420.39
| Facility | | $113.70 | $175.61 | $420.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $110.67 / $164.68 / $1,215.00
| Professional | | $110.67 | $164.68 | $1,215.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $219.65 / $337.55 / $611.50
| Facility | | $219.65 | $337.55 | $611.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.96 / $117.96 / $159.44
| Professional | | $117.96 | $117.96 | $159.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $118.29 / $213.21 / $481.19
| Facility | | $118.29 | $213.21 | $481.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.56 / $137.80 / $336.91
| Professional | | $75.56 | $137.80 | $336.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.43 / $3,472.00 / $9,239.00
| Facility | | $83.43 | $3,472.00 | $9,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.10 / $181.10 / $213.06
| Professional | | $181.10 | $181.10 | $213.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.49 / $247.72 / $408.06
| Professional | | $125.49 | $247.72 | $408.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.74 / $272.81 / $839.45
| Facility | | $145.74 | $272.81 | $839.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $268.18 / $704.00 / $704.00
| Facility | | $268.18 | $704.00 | $704.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.48 / $174.14 / $1,215.00
| Professional | | $104.48 | $174.14 | $1,215.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.48 / $125.49 / $286.12
| Professional | | $104.48 | $125.49 | $286.12 |