- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $316.07 / $316.07 / $578.54
| Facility | | $316.07 | $316.07 | $578.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $46.36 / $74.42 / $118.61
| Professional | | $46.36 | $74.42 | $118.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $54.06 / $86.65 / $139.10
| Professional | | $54.06 | $86.65 | $139.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.26 / $92.15 / $154.41
| Professional | | $67.26 | $92.15 | $154.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.00 / $1,401.00 / $4,915.00
| Facility | | $540.00 | $1,401.00 | $4,915.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.14 / $122.01 / $183.77
| Professional | | $69.14 | $122.01 | $183.77 |