- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $199.53 / $199.53 / $245.47
| Professional | | $199.53 | $199.53 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $588.84
| Professional | | $151.36 | $151.36 | $588.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $208.93 / $281.84 / $2,041.74
| Facility | | $208.93 | $281.84 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $501.19 / $2,951.21
| Professional | | $194.98 | $501.19 | $2,951.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $194.98 / $194.98
| Professional | | $194.98 | $194.98 | $194.98 |