- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.83 / $117.85 / $261.85
| Facility | | $106.83 | $117.85 | $261.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.20 / $108.67 / $117.85
| Professional | | $96.20 | $108.67 | $117.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.01 / $144.47 / $173.50
| Professional | | $100.01 | $144.47 | $173.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $41.61 / $595.39 / $1,564.70
| Facility | | $41.61 | $595.39 | $1,564.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.44 / $159.69 / $210.86
| Professional | | $103.44 | $159.69 | $210.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $5.83 / $337.95
| Professional | | $2.93 | $5.83 | $337.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.70 / $247.70 / $247.70
| Facility | | $247.70 | $247.70 | $247.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2.93 / $2.93 / $2.93
| Professional | | $2.93 | $2.93 | $2.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $561.65 / $561.65 / $561.65
| Facility | | $561.65 | $561.65 | $561.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.63 / $210.31 / $336.13
| Professional | | $96.63 | $210.31 | $336.13 |