- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $98.99 / $114.22 / $133.26
| Facility | | $98.99 | $114.22 | $133.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $98.99 / $118.64 / $653.00
| Professional | | $98.99 | $118.64 | $653.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.86 / $289.86 / $289.86
| Facility | | $289.86 | $289.86 | $289.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.35 / $159.35 / $353.74
| Professional | | $159.35 | $159.35 | $353.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.00 / $175.00 / $213.39
| Facility | | $175.00 | $175.00 | $213.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.75 / $127.75 / $187.98
| Professional | | $127.75 | $127.75 | $187.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $161.19 / $231.89 / $417.40
| Professional | | $161.19 | $231.89 | $417.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.64 / $132.35 / $220.59
| Professional | | $103.64 | $132.35 | $220.59 |