- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.45 / $133.58 / $731.38
| Professional | | $76.45 | $133.58 | $731.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.63 / $292.64 / $714.25
| Facility | | $133.63 | $292.64 | $714.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $591.10 / $591.10 / $1,209.40
| Professional | | $591.10 | $591.10 | $1,209.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.00 / $314.00 / $314.00
| Facility | | $314.00 | $314.00 | $314.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $96.27 / $367.47 / $520.09
| Professional | | $96.27 | $367.47 | $520.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.64 / $432.25 / $439.48
| Professional | | $319.64 | $432.25 | $439.48 |