- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $223.48 / $231.96 / $1,258.23
| Facility | | $223.48 | $231.96 | $1,258.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.02 / $226.30 / $282.88
| Professional | | $198.02 | $226.30 | $282.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.90 / $228.90 / $228.90
| Facility | | $228.90 | $228.90 | $228.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.56 / $228.90 / $228.90
| Professional | | $194.56 | $228.90 | $228.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.46 / $3,712.80 / $8,935.92
| Facility | | $339.46 | $3,712.80 | $8,935.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.31 / $396.03 / $5,249.85
| Professional | | $325.31 | $396.03 | $5,249.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.87 / $220.11 / $373.26
| Facility | | $183.87 | $220.11 | $373.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.16 / $361.24 / $1,363.48
| Professional | | $212.16 | $361.24 | $1,363.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Professional | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.88 / $282.88 / $339.46
| Facility | | $282.88 | $282.88 | $339.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.30 / $169.73 / $311.17
| Professional | | $127.30 | $169.73 | $311.17 |