- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $96.32 / $251.28 / $309.06
| Facility | | $96.32 | $251.28 | $309.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.89 / $66.17 / $68.68
| Professional | | $7.89 | $66.17 | $68.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $17.59 / $251.28 / $454.73
| Facility | | $17.59 | $251.28 | $454.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $14.95 / $17.59 / $57.79
| Professional | | $14.95 | $17.59 | $57.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $83.76 / $104.70 / $1,846.53
| Facility | | $83.76 | $104.70 | $1,846.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $83.76 / $92.14 / $113.08
| Professional | | $83.76 | $92.14 | $113.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.44 / $158.34 / $326.91
| Facility | | $54.44 | $158.34 | $326.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.23 / $102.58 / $120.29
| Professional | | $96.23 | $102.58 | $120.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.18 / $50.26 / $83.76
| Professional | | $35.18 | $50.26 | $83.76 |