- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.76 / $118.25 / $284.45
| Facility | | $75.76 | $118.25 | $284.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.74 / $63.81 / $109.54
| Professional | | $50.74 | $63.81 | $109.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $60.81 / $104.26 / $223.99
| Facility | | $60.81 | $104.26 | $223.99 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $50.24 / $59.47 / $101.43
| Professional | | $50.24 | $59.47 | $101.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.91 / $1,974.91 / $1,974.91
| Facility | | $1,974.91 | $1,974.91 | $1,974.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.81 / $177.81 / $177.81
| Professional | | $177.81 | $177.81 | $177.81 |