- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $145.28 / $246.92 / $592.61
| Facility | | $145.28 | $246.92 | $592.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.35 / $143.35 / $145.28
| Professional | | $143.35 | $143.35 | $145.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.91 / $127.32 / $250.68
| Facility | | $125.91 | $127.32 | $250.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.70 / $283.73 / $354.66
| Professional | | $98.70 | $283.73 | $354.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.67 / $165.44 / $648.92
| Facility | | $102.67 | $165.44 | $648.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $86.36 / $205.63
| Professional | | $81.36 | $86.36 | $205.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.36 / $86.36 / $123.46
| Professional | | $81.36 | $86.36 | $123.46 |