- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.52 / $438.38 / $8,036.88
| Facility | | $109.52 | $438.38 | $8,036.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $108.46 / $438.38
| Professional | | $106.33 | $108.46 | $438.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $159.16 / $159.16
| Professional | | $136.04 | $159.16 | $159.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.33 / $143.55 / $381.94
| Facility | | $106.33 | $143.55 | $381.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $107.29 / $136.04
| Professional | | $106.33 | $107.29 | $136.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.32 / $106.33 / $109.42
| Facility | | $100.32 | $106.33 | $109.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.33 / $106.33 / $135.43
| Professional | | $106.33 | $106.33 | $135.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $136.04 / $190.10 / $417.50
| Facility | | $136.04 | $190.10 | $417.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.04 / $144.19 / $1,358.07
| Professional | | $136.04 | $144.19 | $1,358.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.01 / $107.39 / $130.25
| Professional | | $101.01 | $107.39 | $130.25 |