- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $236.12 / $236.12 / $397.47
| Facility | | $236.12 | $236.12 | $397.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.00 / $256.93 / $397.47
| Professional | | $221.00 | $256.93 | $397.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $106.00 / $106.00 / $106.00
| Professional | | $106.00 | $106.00 | $106.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.00 / $1,000.00 / $1,000.00
| Facility | | $1,000.00 | $1,000.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.05 / $254.92 / $392.18
| Professional | | $158.05 | $254.92 | $392.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $17.00 / $25.00 / $50.00
| Professional | | $17.00 | $25.00 | $50.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.09 / $264.61 / $374.90
| Professional | | $196.09 | $264.61 | $374.90 |