- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $166.60 / $188.81 / $259.00
| Facility | | $166.60 | $188.81 | $259.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.10 / $162.44 / $298.32
| Professional | | $124.10 | $162.44 | $298.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.71 / $818.71 / $818.71
| Facility | | $818.71 | $818.71 | $818.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.25 / $232.94 / $1,080.07
| Professional | | $142.25 | $232.94 | $1,080.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $201.72 / $253.65 / $286.99
| Facility | | $201.72 | $253.65 | $286.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.41 / $297.70 / $431.10
| Professional | | $215.41 | $297.70 | $431.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $70.00 / $202.00 / $572.22
| Professional | | $70.00 | $202.00 | $572.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.00 / $84.00 / $102.86
| Facility | | $84.00 | $84.00 | $102.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.00 / $173.91 / $312.99
| Professional | | $84.00 | $173.91 | $312.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $176.17 / $369.28 / $528.34
| Professional | | $176.17 | $369.28 | $528.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $182.53 / $209.92 / $245.00
| Facility | | $182.53 | $209.92 | $245.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.56 / $246.95 / $425.89
| Professional | | $192.56 | $246.95 | $425.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.71 / $818.71 / $818.71
| Facility | | $818.71 | $818.71 | $818.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.22 / $214.40 / $1,234.10
| Professional | | $132.22 | $214.40 | $1,234.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $49.22 / $68.40 / $89.89
| Facility | | $49.22 | $68.40 | $89.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.97 / $168.27 / $313.08
| Professional | | $114.97 | $168.27 | $313.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $119.20 / $196.55 / $431.38
| Professional | | $119.20 | $196.55 | $431.38 |