- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $251.19 / $524.81
| Facility | | $173.78 | $251.19 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $128.82 / $169.82
| Professional | | $95.50 | $128.82 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.78 / $275.42 / $467.74
| Facility | | $173.78 | $275.42 | $467.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $173.78 / $251.19
| Professional | | $89.13 | $173.78 | $251.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $1,000.00
| Facility | | $114.82 | $114.82 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $323.59 / $380.19
| Professional | | $234.42 | $323.59 | $380.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.18 / $104.71 / $309.03
| Professional | | $83.18 | $104.71 | $309.03 |