- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.20 / $546.51 / $759.65
| Professional | | $100.20 | $546.51 | $759.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $160.37 / $160.37 / $160.37
| Facility | | $160.37 | $160.37 | $160.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.31 / $160.37 / $229.77
| Professional | | $136.31 | $160.37 | $229.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.69 / $142.12 / $230.18
| Facility | | $90.69 | $142.12 | $230.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.00 / $179.55 / $272.27
| Professional | | $133.00 | $179.55 | $272.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.04 / $239.54 / $261.76
| Professional | | $204.04 | $239.54 | $261.76 |