- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.56 / $108.48 / $156.63
| Facility | | $80.56 | $108.48 | $156.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.00 / $134.83 / $209.41
| Professional | | $112.00 | $134.83 | $209.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $134.83 / $158.62 / $8,639.91
| Facility | | $134.83 | $158.62 | $8,639.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.69 / $150.69 / $150.69
| Professional | | $150.69 | $150.69 | $150.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Facility | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Professional | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.43 / $129.43 / $196.00
| Facility | | $129.43 | $129.43 | $196.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $68.59 / $134.83 / $229.12
| Facility | | $68.59 | $134.83 | $229.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.80 / $134.83 / $209.41
| Professional | | $107.80 | $134.83 | $209.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Facility | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.32 / $148.32 / $148.32
| Professional | | $148.32 | $148.32 | $148.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.57 / $123.57 / $123.57
| Facility | | $123.57 | $123.57 | $123.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.57 / $123.57 / $123.57
| Professional | | $123.57 | $123.57 | $123.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.43 / $158.62 / $216.27
| Professional | | $132.43 | $158.62 | $216.27 |