- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $177.83 / $316.23
| Professional | | $128.82 | $177.83 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $851.14 / $851.14 / $851.14
| Facility | | $851.14 | $851.14 | $851.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $575.44
| Facility | | $575.44 | $575.44 | $575.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $199.53 / $524.81
| Professional | | $173.78 | $199.53 | $524.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $213.80 / $562.34
| Professional | | $141.25 | $213.80 | $562.34 |