- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.62 / $459.24 / $459.24
| Professional | | $86.62 | $459.24 | $459.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.10 / $135.13 / $380.36
| Facility | | $100.10 | $135.13 | $380.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.66 / $139.22 / $235.89
| Professional | | $117.66 | $139.22 | $235.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $100.10 / $135.13 / $380.36
| Facility | | $100.10 | $135.13 | $380.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $75.05 / $106.33 / $159.94
| Professional | | $75.05 | $106.33 | $159.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $68.41 / $90.39 / $157.41
| Professional | | $68.41 | $90.39 | $157.41 |