- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.41 / $249.68 / $910.12
| Facility | | $183.41 | $249.68 | $910.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.77 / $192.06 / $224.94
| Professional | | $129.77 | $192.06 | $224.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $112.47 / $1,223.01 / $1,314.71
| Facility | | $112.47 | $1,223.01 | $1,314.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $91.71 / $161.81 / $248.83
| Professional | | $91.71 | $161.81 | $248.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.20 / $86.52 / $259.55
| Professional | | $69.20 | $86.52 | $259.55 |