- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $186.52 / $222.87 / $291.64
| Facility | | $186.52 | $222.87 | $291.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $59.66 / $59.66 / $59.66
| Professional | | $59.66 | $59.66 | $59.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $87.00 / $104.00 / $151.00
| Professional | | $87.00 | $104.00 | $151.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.23 / $80.68 / $121.57
| Professional | | $69.23 | $80.68 | $121.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.09 / $123.37 / $199.33
| Professional | | $78.09 | $123.37 | $199.33 |