- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.48 / $411.48 / $835.85
| Facility | | $127.48 | $411.48 | $835.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.81 / $121.68 / $127.48
| Professional | | $105.81 | $121.68 | $127.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.00 / $162.00 / $202.50
| Professional | | $162.00 | $162.00 | $202.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $37.69 / $193.89 / $292.20
| Facility | | $37.69 | $193.89 | $292.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $106.24 / $117.09
| Professional | | $106.24 | $106.24 | $117.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.13 / $169.31 / $346.34
| Facility | | $136.13 | $169.31 | $346.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.40 / $186.00 / $346.34
| Professional | | $167.40 | $186.00 | $346.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $108.36 / $108.36 / $108.36
| Professional | | $108.36 | $108.36 | $108.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.24 / $106.24 / $116.86
| Professional | | $106.24 | $106.24 | $116.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.73 / $114.73 / $114.73
| Professional | | $114.73 | $114.73 | $114.73 |