- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $99.48 / $128.85 / $192.59
| Facility | | $99.48 | $128.85 | $192.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.90 / $123.13 / $192.59
| Professional | | $82.90 | $123.13 | $192.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $206.00 / $264.82 / $440.23
| Facility | | $206.00 | $264.82 | $440.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.74 / $112.63 / $162.41
| Professional | | $95.74 | $112.63 | $162.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.89 / $139.82 / $229.61
| Professional | | $92.89 | $139.82 | $229.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $82.90 / $145.65 / $390.00
| Facility | | $82.90 | $145.65 | $390.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.12 / $160.55 / $914.72
| Professional | | $125.12 | $160.55 | $914.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.00 / $550.00 / $1,769.00
| Facility | | $191.00 | $550.00 | $1,769.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.11 / $141.05 / $199.00
| Professional | | $121.11 | $141.05 | $199.00 |