- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.76 / $210.76 / $210.76
| Facility | | $210.76 | $210.76 | $210.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.86 / $207.35 / $210.76
| Professional | | $197.86 | $207.35 | $210.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $196.21 / $196.21 / $346.46
| Facility | | $196.21 | $196.21 | $346.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $351.75 / $351.75 / $439.69
| Professional | | $351.75 | $351.75 | $439.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $215.25 / $350.42 / $1,587.88
| Facility | | $215.25 | $350.42 | $1,587.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.84 / $193.34 / $360.00
| Professional | | $120.84 | $193.34 | $360.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $288.08 / $346.46 / $582.09
| Facility | | $288.08 | $346.46 | $582.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.75 / $351.34 / $662.10
| Professional | | $283.75 | $351.34 | $662.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $253.01 / $296.22 / $352.11
| Professional | | $253.01 | $296.22 | $352.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.84 / $201.77 / $333.66
| Professional | | $120.84 | $201.77 | $333.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $308.66 / $308.66 / $308.66
| Professional | | $308.66 | $308.66 | $308.66 |