- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.76 / $93.76 / $588.00
| Facility | | $93.76 | $93.76 | $588.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.46 / $114.99 / $302.47
| Professional | | $91.46 | $114.99 | $302.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.62 / $176.62 / $190.11
| Professional | | $173.62 | $176.62 | $190.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.53 / $125.87 / $217.46
| Professional | | $121.53 | $125.87 | $217.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.90 / $132.90 / $132.90
| Facility | | $132.90 | $132.90 | $132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.51 / $142.19 / $229.05
| Professional | | $108.51 | $142.19 | $229.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $249.67 / $249.67 / $249.67
| Facility | | $249.67 | $249.67 | $249.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $130.26 / $171.06 / $310.80
| Professional | | $130.26 | $171.06 | $310.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.32 / $195.70 / $1,517.75
| Professional | | $151.32 | $195.70 | $1,517.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $93.76 / $93.76 / $588.00
| Facility | | $93.76 | $93.76 | $588.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.76 / $165.34 / $310.04
| Professional | | $93.76 | $165.34 | $310.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.00 / $136.00 / $136.00
| Facility | | $136.00 | $136.00 | $136.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.00 / $184.70 / $262.83
| Professional | | $136.00 | $184.70 | $262.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.90 / $132.90 / $132.90
| Facility | | $132.90 | $132.90 | $132.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.51 / $141.99 / $229.05
| Professional | | $108.51 | $141.99 | $229.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $111.46 / $115.01 / $119.08
| Professional | | $111.46 | $115.01 | $119.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.49 / $138.33 / $214.27
| Professional | | $105.49 | $138.33 | $214.27 |