- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.78 / $196.83 / $393.67
| Facility | | $110.78 | $196.83 | $393.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.25 / $132.44 / $209.35
| Professional | | $120.25 | $132.44 | $209.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.52 / $265.75 / $482.50
| Facility | | $236.52 | $265.75 | $482.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.31 / $127.31 / $137.49
| Professional | | $127.31 | $127.31 | $137.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.59 / $130.59 / $130.59
| Facility | | $130.59 | $130.59 | $130.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.33 / $130.59 / $195.80
| Professional | | $95.33 | $130.59 | $195.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $67.31 / $129.02 / $314.27
| Facility | | $67.31 | $129.02 | $314.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.31 / $67.31 / $67.31
| Professional | | $67.31 | $67.31 | $67.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.66 / $295.64 / $468.31
| Professional | | $172.66 | $295.64 | $468.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $94.68 / $104.27 / $157.07
| Professional | | $94.68 | $104.27 | $157.07 |