- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $234.42 / $436.52
| Facility | | $97.72 | $234.42 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $97.72 / $97.72 / $102.33
| Professional | | $97.72 | $97.72 | $102.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $117.49 / $151.36 / $234.42
| Facility | | $117.49 | $151.36 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $11.48 / $15.49 / $74.13
| Professional | | $11.48 | $15.49 | $74.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12.30 / $21.88 / $22.91
| Facility | | $12.30 | $21.88 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $12.30 / $13.18 / $275.42
| Professional | | $12.30 | $13.18 | $275.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $22.91 / $22.91 / $22.91
| Facility | | $22.91 | $22.91 | $22.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $120.23
| Professional | | $102.33 | $102.33 | $120.23 |