- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $1,295.81
| Facility | | $350.00 | $350.00 | $1,295.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.00 / $350.00 / $350.00
| Professional | | $350.00 | $350.00 | $350.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $106.54 / $109.58 / $343.44
| Facility | | $106.54 | $109.58 | $343.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $38.47 / $107.05 / $228.25
| Professional | | $38.47 | $107.05 | $228.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.64 / $143.34 / $504.79
| Facility | | $124.64 | $143.34 | $504.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.06 / $134.31 / $157.03
| Professional | | $107.06 | $134.31 | $157.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.97 / $52.35 / $74.78
| Professional | | $32.97 | $52.35 | $74.78 |