- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $129.83 / $150.93 / $165.98
| Professional | | $129.83 | $150.93 | $165.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $194.04 / $461.66 / $584.02
| Facility | | $194.04 | $461.66 | $584.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.80 / $538.80 / $538.80
| Professional | | $538.80 | $538.80 | $538.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $582.11 / $1,102.08
| Facility | | $331.13 | $582.11 | $1,102.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.84 / $397.66 / $515.58
| Professional | | $212.84 | $397.66 | $515.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.51 / $238.48 / $330.69
| Professional | | $82.51 | $238.48 | $330.69 |