- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.40 / $140.66 / $140.66
| Professional | | $121.40 | $140.66 | $140.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $225.93 / $312.08 / $512.19
| Facility | | $225.93 | $312.08 | $512.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $145.10 / $146.62 / $208.47
| Professional | | $145.10 | $146.62 | $208.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.49 / $130.49 / $130.49
| Facility | | $130.49 | $130.49 | $130.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.67 / $163.75 / $259.81
| Professional | | $124.67 | $163.75 | $259.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.61 / $166.92 / $261.20
| Professional | | $129.61 | $166.92 | $261.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.40 / $140.66 / $140.66
| Professional | | $121.40 | $140.66 | $140.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $113.65 / $172.10 / $265.00
| Professional | | $113.65 | $172.10 | $265.00 |