- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.19 / $168.75 / $275.42
| Facility | | $104.19 | $168.75 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $71.18 / $125.07 / $187.17
| Professional | | $71.18 | $125.07 | $187.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $145.15
| Professional | | $100.00 | $100.00 | $145.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.69 / $110.56 / $240.49
| Professional | | $82.69 | $110.56 | $240.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.34 / $131.34 / $131.34
| Facility | | $131.34 | $131.34 | $131.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.34 / $131.34 / $213.94
| Professional | | $131.34 | $131.34 | $213.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.77 / $125.77 / $125.77
| Facility | | $125.77 | $125.77 | $125.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.70 / $176.14 / $414.17
| Professional | | $87.70 | $176.14 | $414.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.67 / $41.67 / $319.00
| Facility | | $41.67 | $41.67 | $319.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.66 / $223.10 / $303.83
| Professional | | $157.66 | $223.10 | $303.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.60 / $90.60 / $140.02
| Facility | | $90.60 | $90.60 | $140.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.82 / $156.87 / $311.04
| Professional | | $123.82 | $156.87 | $311.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.77 / $125.77 / $555.00
| Facility | | $125.77 | $125.77 | $555.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.01 / $174.57 / $414.17
| Professional | | $102.01 | $174.57 | $414.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.49 / $168.17 / $359.82
| Professional | | $116.49 | $168.17 | $359.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.08 / $113.08 / $140.02
| Facility | | $113.08 | $113.08 | $140.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.41 / $184.55 / $309.72
| Professional | | $138.41 | $184.55 | $309.72 |