- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.49 / $190.55 / $446.68
| Professional | | $158.49 | $190.55 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $407.38 / $478.63
| Professional | | $281.84 | $407.38 | $478.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $263.03 / $380.19
| Professional | | $218.78 | $263.03 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.81 / $794.33 / $3,235.94
| Facility | | $524.81 | $794.33 | $3,235.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $229.09 / $331.13 / $645.65
| Professional | | $229.09 | $331.13 | $645.65 |