- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $295.12 / $323.59 / $363.08
| Facility | | $295.12 | $323.59 | $363.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.65 / $109.65 / $239.88
| Professional | | $43.65 | $109.65 | $239.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $36.31 / $75.86 / $138.04
| Professional | | $36.31 | $75.86 | $138.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.29 / $100.00 / $169.82
| Professional | | $51.29 | $100.00 | $169.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $1,412.54 / $6,456.54
| Facility | | $338.84 | $1,412.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $44.67 / $83.18 / $165.96
| Professional | | $44.67 | $83.18 | $165.96 |