- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.81 / $97.81 / $343.00
| Facility | | $97.81 | $97.81 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.44 / $121.48 / $323.00
| Professional | | $95.44 | $121.48 | $323.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.50 / $225.28 / $845.76
| Professional | | $125.50 | $225.28 | $845.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.16 / $130.66 / $225.88
| Professional | | $126.16 | $130.66 | $225.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.29 / $138.29 / $138.29
| Facility | | $138.29 | $138.29 | $138.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.64 / $148.52 / $238.36
| Professional | | $112.64 | $148.52 | $238.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.04 / $259.04 / $259.04
| Facility | | $259.04 | $259.04 | $259.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.07 / $177.31 / $322.14
| Professional | | $135.07 | $177.31 | $322.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.85 / $184.73 / $1,166.09
| Professional | | $148.85 | $184.73 | $1,166.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.81 / $97.81 / $343.00
| Facility | | $97.81 | $97.81 | $343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.81 / $168.50 / $328.54
| Professional | | $97.81 | $168.50 | $328.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.40 / $148.40 / $148.40
| Facility | | $148.40 | $148.40 | $148.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.40 / $192.00 / $272.81
| Professional | | $148.40 | $192.00 | $272.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.29 / $138.29 / $138.29
| Facility | | $138.29 | $138.29 | $138.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.64 / $147.81 / $238.36
| Professional | | $112.64 | $147.81 | $238.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.71 / $119.33 / $169.80
| Professional | | $115.71 | $119.33 | $169.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.91 / $144.18 / $218.49
| Professional | | $111.91 | $144.18 | $218.49 |