- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.03 / $309.03 / $933.25
| Facility | | $309.03 | $309.03 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $251.19 / $309.03
| Professional | | $245.47 | $251.19 | $309.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1.00 / $75.86 / $117.49
| Facility | | $1.00 | $75.86 | $117.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $24.55 / $30.20 / $30.20
| Professional | | $24.55 | $30.20 | $30.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $141.25 / $338.84
| Facility | | $100.00 | $141.25 | $338.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $371.54 / $407.38
| Professional | | $323.59 | $371.54 | $407.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.65 / $151.36 / $263.03
| Facility | | $109.65 | $151.36 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $323.59 / $436.52
| Professional | | $323.59 | $323.59 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $263.03 / $309.03 / $562.34
| Facility | | $263.03 | $309.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $501.19
| Professional | | $257.04 | $257.04 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.03 / $263.03 / $467.74
| Professional | | $263.03 | $263.03 | $467.74 |