- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.40 / $213.34 / $774.69
| Professional | | $154.40 | $213.34 | $774.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.39 / $242.39 / $242.39
| Facility | | $242.39 | $242.39 | $242.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $116.91 / $218.15 / $242.69
| Professional | | $116.91 | $218.15 | $242.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.72 / $152.15 / $242.39
| Facility | | $121.72 | $152.15 | $242.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.96 / $235.09 / $315.56
| Professional | | $143.96 | $235.09 | $315.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $197.42 / $234.07 / $301.70
| Professional | | $197.42 | $234.07 | $301.70 |