- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.72 / $142.69 / $194.58
| Facility | | $129.72 | $142.69 | $194.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.72 / $129.72 / $129.72
| Professional | | $129.72 | $129.72 | $129.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.72 / $136.21 / $5,622.32
| Facility | | $129.72 | $136.21 | $5,622.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.08 / $200.76 / $6,299.47
| Professional | | $150.08 | $200.76 | $6,299.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.78 / $181.14 / $302.25
| Professional | | $147.78 | $181.14 | $302.25 |