- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $178.47 / $253.22 / $609.16
| Facility | | $178.47 | $253.22 | $609.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.93 / $223.99 / $314.72
| Professional | | $139.93 | $223.99 | $314.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.60 / $223.26 / $479.65
| Facility | | $140.60 | $223.26 | $479.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.08 / $193.30 / $287.75
| Professional | | $120.08 | $193.30 | $287.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.67 / $104.67 / $104.67
| Facility | | $104.67 | $104.67 | $104.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,793.57 / $1,793.57 / $1,793.57
| Professional | | $1,793.57 | $1,793.57 | $1,793.57 |