- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $74.38 / $137.32 / $495.48
| Facility | | $74.38 | $137.32 | $495.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.66 / $74.38 / $82.39
| Professional | | $68.66 | $74.38 | $82.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.41 / $87.91 / $430.68
| Facility | | $63.41 | $87.91 | $430.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.65 / $131.75 / $174.49
| Professional | | $60.65 | $131.75 | $174.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.01 / $68.66 / $135.59
| Professional | | $50.01 | $68.66 | $135.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.43 / $114.43 / $114.43
| Facility | | $114.43 | $114.43 | $114.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.04 / $48.06 / $148.94
| Professional | | $40.04 | $48.06 | $148.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.27 / $68.66 / $68.66
| Professional | | $59.27 | $68.66 | $68.66 |