- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.33 / $114.82 / $173.78
| Facility | | $102.33 | $114.82 | $173.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $109.65 / $269.15
| Professional | | $83.18 | $109.65 | $269.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $602.56
| Facility | | $70.79 | $125.89 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $141.25 / $323.59
| Professional | | $93.33 | $141.25 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $109.65 / $251.19
| Facility | | $109.65 | $109.65 | $251.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.65 / $186.21 / $263.03
| Professional | | $109.65 | $186.21 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.20 / $131.83 / $239.88
| Professional | | $91.20 | $131.83 | $239.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $85.11 / $85.11 / $109.65
| Facility | | $85.11 | $85.11 | $109.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $120.23 / $218.78
| Professional | | $63.10 | $120.23 | $218.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $169.82 / $281.84
| Professional | | $100.00 | $169.82 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $141.25 / $177.83
| Professional | | $117.49 | $141.25 | $177.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.79 / $125.89 / $602.56
| Facility | | $70.79 | $125.89 | $602.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $141.25 / $323.59
| Professional | | $95.50 | $141.25 | $323.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.20 / $112.20 / $112.20
| Facility | | $112.20 | $112.20 | $112.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $138.04 / $269.15
| Professional | | $93.33 | $138.04 | $269.15 |