- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $239.88 / $416.87
| Facility | | $144.54 | $239.88 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.49 / $141.25 / $173.78
| Professional | | $117.49 | $141.25 | $173.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $144.54 / $173.78 / $186.21
| Facility | | $144.54 | $173.78 | $186.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $141.25 / $141.25
| Professional | | $125.89 | $141.25 | $141.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $169.82 / $213.80 / $295.12
| Facility | | $169.82 | $213.80 | $295.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $218.78 / $288.40
| Professional | | $186.21 | $218.78 | $288.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $239.88 / $281.84
| Facility | | $114.82 | $239.88 | $281.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $281.84 / $851.14
| Professional | | $79.43 | $281.84 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $104.71 / $173.78
| Professional | | $74.13 | $104.71 | $173.78 |