- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.62 / $185.82 / $334.98
| Professional | | $69.62 | $185.82 | $334.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,065.27 / $3,065.27 / $3,847.60
| Facility | | $3,065.27 | $3,065.27 | $3,847.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $88.44 / $260.91 / $555.59
| Professional | | $88.44 | $260.91 | $555.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.53 / $305.89 / $555.59
| Professional | | $153.53 | $305.89 | $555.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.20 / $384.13 / $1,135.18
| Professional | | $303.20 | $384.13 | $1,135.18 |