- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.65 / $238.46 / $483.72
| Facility | | $195.65 | $238.46 | $483.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $274.79
| Professional | | $227.28 | $227.28 | $274.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $400.00 / $400.00 / $400.00
| Professional | | $400.00 | $400.00 | $400.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.79 / $143.62 / $231.17
| Facility | | $98.79 | $143.62 | $231.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.17 / $231.17 / $235.79
| Professional | | $231.17 | $231.17 | $235.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $13,933.49 / $13,933.49 / $13,933.49
| Facility | | $13,933.49 | $13,933.49 | $13,933.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.41 / $214.41 / $227.28
| Facility | | $214.41 | $214.41 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Professional | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $227.28 / $227.28 / $227.28
| Facility | | $227.28 | $227.28 | $227.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.55 / $227.28 / $276.91
| Professional | | $204.55 | $227.28 | $276.91 |