- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.68 / $122.15 / $883.98
| Facility | | $117.68 | $122.15 | $883.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.68 / $122.15 / $158.99
| Professional | | $117.68 | $122.15 | $158.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.72 / $178.87 / $208.88
| Facility | | $123.72 | $178.87 | $208.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $64.56 / $86.09 / $182.94
| Professional | | $64.56 | $86.09 | $182.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $238.49 / $2,608.46 / $6,270.48
| Facility | | $238.49 | $2,608.46 | $6,270.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.55 / $278.24 / $3,683.91
| Professional | | $228.55 | $278.24 | $3,683.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.91 / $151.66 / $238.49
| Facility | | $115.91 | $151.66 | $238.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.67 / $957.93 / $957.93
| Professional | | $230.67 | $957.93 | $957.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.48 / $99.31 / $165.52
| Professional | | $74.48 | $99.31 | $165.52 |