- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $240.83 / $319.95 / $667.21
| Professional | | $240.83 | $319.95 | $667.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $519.05 / $940.61 / $1,198.83
| Facility | | $519.05 | $940.61 | $1,198.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $51.47 / $99.10 / $99.10
| Professional | | $51.47 | $99.10 | $99.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.01 / $654.17 / $1,150.01
| Facility | | $213.01 | $654.17 | $1,150.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $62.21 / $103.83 / $150.63
| Professional | | $62.21 | $103.83 | $150.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.22 / $532.84 / $1,123.46
| Professional | | $67.22 | $532.84 | $1,123.46 |