- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.06 / $173.41 / $752.49
| Facility | | $130.06 | $173.41 | $752.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.18 / $160.93 / $300.00
| Professional | | $116.18 | $160.93 | $300.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.00 / $176.60 / $176.60
| Facility | | $120.00 | $176.60 | $176.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.68 / $175.43 / $220.81
| Professional | | $148.68 | $175.43 | $220.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.00 / $100.00 / $100.00
| Facility | | $100.00 | $100.00 | $100.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.00 / $147.00 / $266.60
| Professional | | $75.00 | $147.00 | $266.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.19 / $170.31 / $236.16
| Professional | | $118.19 | $170.31 | $236.16 |