- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $69.89 / $73.02 / $156.91
| Professional | | $69.89 | $73.02 | $156.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,962.21 / $1,962.21 / $2,191.36
| Facility | | $1,962.21 | $1,962.21 | $2,191.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.25 / $147.43 / $287.83
| Professional | | $80.25 | $147.43 | $287.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.97 / $150.32 / $287.83
| Professional | | $80.97 | $150.32 | $287.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.23 / $191.78 / $525.54
| Professional | | $171.23 | $191.78 | $525.54 |