- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.36 / $106.36 / $1,643.97
| Facility | | $106.36 | $106.36 | $1,643.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.80 / $115.65 / $1,432.80
| Professional | | $100.80 | $115.65 | $1,432.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.25 / $140.50 / $145.00
| Professional | | $28.25 | $140.50 | $145.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.15 / $329.51 / $542.35
| Facility | | $90.15 | $329.51 | $542.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.14 / $97.52 / $472.36
| Professional | | $73.14 | $97.52 | $472.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.36 / $108.36 / $108.36
| Facility | | $108.36 | $108.36 | $108.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.36 / $108.36 / $108.36
| Professional | | $108.36 | $108.36 | $108.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.53 / $147.66 / $431.25
| Facility | | $104.53 | $147.66 | $431.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $106.24 / $230.54
| Professional | | $106.24 | $106.24 | $230.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $106.24 / $106.24
| Professional | | $106.24 | $106.24 | $106.24 |