- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.24 / $177.24 / $177.24
| Facility | | $177.24 | $177.24 | $177.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.09 / $177.24 / $293.82
| Professional | | $156.09 | $177.24 | $293.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $427.71 / $723.61 / $3,081.16
| Facility | | $427.71 | $723.61 | $3,081.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.16 / $272.16 / $272.16
| Professional | | $272.16 | $272.16 | $272.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.66 / $231.66 / $391.93
| Facility | | $231.66 | $231.66 | $391.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.11 / $231.66 / $415.13
| Professional | | $169.11 | $231.66 | $415.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.20 / $413.11 / $501.34
| Professional | | $340.20 | $413.11 | $501.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.53 / $465.53 / $465.53
| Professional | | $465.53 | $465.53 | $465.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.01 / $178.65 / $316.33
| Professional | | $133.01 | $178.65 | $316.33 |