- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.74 / $176.08 / $274.35
| Facility | | $146.74 | $176.08 | $274.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.74 / $146.74 / $192.67
| Professional | | $146.74 | $146.74 | $192.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $180.36 / $203.33 / $650.00
| Professional | | $180.36 | $203.33 | $650.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.57 / $259.57 / $259.57
| Professional | | $259.57 | $259.57 | $259.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $127.41 / $127.41 / $127.41
| Professional | | $127.41 | $127.41 | $127.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $146.74 / $176.08 / $274.35
| Facility | | $146.74 | $176.08 | $274.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.74 / $146.74 / $192.67
| Professional | | $146.74 | $146.74 | $192.67 |