- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.11 / $501.19 / $501.19
| Facility | | $33.11 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.20 / $45.71 / $724.44
| Professional | | $30.20 | $45.71 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $575.44 / $812.83
| Professional | | $346.74 | $575.44 | $812.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $524.81 / $524.81
| Facility | | $524.81 | $524.81 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.88 / $562.34 / $933.25
| Professional | | $154.88 | $562.34 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $52.48 / $70.79 / $109.65
| Professional | | $52.48 | $70.79 | $109.65 |