- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $107.15 / $371.54 / $467.74
| Facility | | $107.15 | $371.54 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $107.15 / $371.54
| Professional | | $104.71 | $107.15 | $371.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $104.71 / $123.03
| Professional | | $89.13 | $104.71 | $123.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.49 / $165.96 / $165.96
| Facility | | $158.49 | $165.96 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $104.71 / $104.71
| Facility | | $100.00 | $104.71 | $104.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $104.71
| Professional | | $104.71 | $104.71 | $104.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $158.49 / $354.81
| Facility | | $114.82 | $158.49 | $354.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $194.98
| Professional | | $114.82 | $114.82 | $194.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.71 / $112.20 / $134.90
| Facility | | $104.71 | $112.20 | $134.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $177.83
| Professional | | $104.71 | $104.71 | $177.83 |