- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.47 / $157.47 / $766.32
| Facility | | $157.47 | $157.47 | $766.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.46 / $173.17 / $241.62
| Professional | | $157.46 | $173.17 | $241.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.72 / $156.72 / $156.72
| Professional | | $156.72 | $156.72 | $156.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $45.00 / $60.00
| Professional | | $30.00 | $45.00 | $60.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $522.74 / $651.80 / $935.77
| Facility | | $522.74 | $651.80 | $935.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.48 / $244.21 / $287.31
| Professional | | $196.48 | $244.21 | $287.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.77 / $230.11 / $334.85
| Professional | | $151.77 | $230.11 | $334.85 |