- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $159.72 / $399.30 / $1,723.72
| Facility | | $159.72 | $399.30 | $1,723.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.72 / $235.05 / $256.14
| Professional | | $159.72 | $235.05 | $256.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.57 / $445.02 / $948.61
| Facility | | $294.57 | $445.02 | $948.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.95 / $394.77 / $549.05
| Professional | | $210.95 | $394.77 | $549.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.38 / $192.38 / $8,702.00
| Facility | | $192.38 | $192.38 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.57 / $180.81 / $307.38
| Professional | | $126.57 | $180.81 | $307.38 |