- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.51 / $185.51 / $3,511.00
| Facility | | $185.51 | $185.51 | $3,511.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.26 / $185.51 / $185.51
| Professional | | $181.26 | $185.51 | $185.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.13 / $316.26 / $391.41
| Professional | | $313.13 | $316.26 | $391.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $259.20 / $306.33 / $496.65
| Facility | | $259.20 | $306.33 | $496.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $216.85 / $367.74 / $1,413.36
| Professional | | $216.85 | $367.74 | $1,413.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.09 / $330.48 / $1,958.04
| Facility | | $218.09 | $330.48 | $1,958.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.52 / $285.39 / $351.76
| Professional | | $259.52 | $285.39 | $351.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,000.00 / $2,000.00 / $2,000.00
| Facility | | $2,000.00 | $2,000.00 | $2,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.64 / $367.74 / $516.24
| Professional | | $220.64 | $367.74 | $516.24 |