- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.01 / $137.36 / $159.78
| Professional | | $115.01 | $137.36 | $159.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $269.52 / $326.33 / $342.22
| Facility | | $269.52 | $326.33 | $342.22 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.05 / $187.63 / $187.63
| Professional | | $76.05 | $187.63 | $187.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.66 / $544.66 / $544.66
| Facility | | $544.66 | $544.66 | $544.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.88 / $202.06 / $293.89
| Professional | | $146.88 | $202.06 | $293.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.32 / $174.84 / $241.33
| Professional | | $122.32 | $174.84 | $241.33 |