- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.71 / $385.20 / $740.76
| Facility | | $193.71 | $385.20 | $740.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.83 / $174.79 / $205.63
| Professional | | $139.83 | $174.79 | $205.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.07 / $220.99 / $740.76
| Facility | | $195.07 | $220.99 | $740.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.90 / $52.41 / $133.27
| Professional | | $38.90 | $52.41 | $133.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.92 / $308.64 / $5,439.86
| Facility | | $246.92 | $308.64 | $5,439.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.92 / $271.61 / $333.34
| Professional | | $246.92 | $271.61 | $333.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.50 / $193.71 / $432.06
| Facility | | $160.50 | $193.71 | $432.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.25 / $283.73 / $354.66
| Professional | | $237.25 | $283.73 | $354.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $193.71 / $193.71 / $193.71
| Facility | | $193.71 | $193.71 | $193.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $118.43 / $185.07
| Professional | | $81.36 | $118.43 | $185.07 |