- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $436.52 / $831.76
| Facility | | $123.03 | $436.52 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $123.03 / $141.25 / $194.98
| Professional | | $123.03 | $141.25 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,071.52 / $1,071.52 / $1,148.15
| Facility | | $1,071.52 | $1,071.52 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.00 / $173.78 / $245.47
| Professional | | $100.00 | $173.78 | $245.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $446.68 / $1,000.00
| Facility | | $114.82 | $446.68 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $79.43 / $83.18 / $229.09
| Professional | | $79.43 | $83.18 | $229.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $123.03 / $158.49 / $302.00
| Facility | | $123.03 | $158.49 | $302.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $173.78 / $208.93
| Facility | | $158.49 | $173.78 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $104.71 / $173.78
| Professional | | $74.13 | $104.71 | $173.78 |