- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.08 / $314.52 / $532.51
| Facility | | $187.08 | $314.52 | $532.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.00 / $219.81 / $307.50
| Professional | | $150.00 | $219.81 | $307.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.00 / $154.00 / $237.06
| Professional | | $154.00 | $154.00 | $237.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $241.37 / $241.37 / $241.37
| Facility | | $241.37 | $241.37 | $241.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.37 / $241.37 / $258.61
| Professional | | $241.37 | $241.37 | $258.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.08 / $198.30 / $284.47
| Facility | | $187.08 | $198.30 | $284.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.60 / $159.60 / $159.60
| Professional | | $159.60 | $159.60 | $159.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.51 / $241.37 / $258.61
| Professional | | $215.51 | $241.37 | $258.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.68 / $245.68 / $517.22
| Facility | | $245.68 | $245.68 | $517.22 |