- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $76.84 / $159.31 / $1,191.48
| Facility | | $76.84 | $159.31 | $1,191.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $28.48 / $159.31 / $487.17
| Professional | | $28.48 | $159.31 | $487.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $13.57 / $34.03 / $316.73
| Professional | | $13.57 | $34.03 | $316.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.62 / $166.16 / $175.29
| Facility | | $158.62 | $166.16 | $175.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $23.20 / $297.08 / $933.74
| Professional | | $23.20 | $297.08 | $933.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.46 / $323.26 / $401.08
| Professional | | $183.46 | $323.26 | $401.08 |