- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.98 / $193.62 / $582.91
| Facility | | $101.98 | $193.62 | $582.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.98 / $101.98 / $105.81
| Professional | | $101.98 | $101.98 | $105.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $108.50 / $113.03 / $125.36
| Facility | | $108.50 | $113.03 | $125.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $41.80 / $184.47 / $217.01
| Professional | | $41.80 | $184.47 | $217.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.69 / $106.04 / $164.30
| Facility | | $102.69 | $106.04 | $164.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.29 / $112.96 / $158.13
| Professional | | $87.29 | $112.96 | $158.13 |
- 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
- $91.12 / $108.36 / $146.05
| Professional | | $91.12 | $108.36 | $146.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $45.00 / $45.00
| Professional | | $45.00 | $45.00 | $45.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $106.24 / $113.78
| Professional | | $106.24 | $106.24 | $113.78 |