- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.34 / $262.32 / $393.48
| Facility | | $140.34 | $262.32 | $393.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.15 / $144.27 / $2,056.54
| Professional | | $131.15 | $144.27 | $2,056.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.93 / $338.52 / $653.83
| Facility | | $104.93 | $338.52 | $653.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.87 / $127.82 / $834.32
| Professional | | $87.87 | $127.82 | $834.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Facility | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $131.16
| Professional | | $131.16 | $131.16 | $131.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $128.66 / $159.76 / $392.50
| Facility | | $128.66 | $159.76 | $392.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.04 / $132.04 / $145.66
| Professional | | $132.04 | $132.04 | $145.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $131.16 / $132.04
| Professional | | $131.16 | $131.16 | $132.04 |