- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $223.87 / $288.40
| Professional | | $190.55 | $223.87 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $218.78 / $245.47
| Professional | | $199.53 | $218.78 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $144.54 / $144.54
| Professional | | $144.54 | $144.54 | $144.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $316.23 / $416.87
| Professional | | $275.42 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $208.93
| Facility | | $114.82 | $114.82 | $208.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $123.03 / $223.87
| Professional | | $114.82 | $123.03 | $223.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.04 / $138.04 / $138.04
| Professional | | $138.04 | $138.04 | $138.04 |