- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $85.11 / $165.96
| Facility | | $63.10 | $85.11 | $165.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $63.10 / $85.11 / $275.42
| Professional | | $63.10 | $85.11 | $275.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.23 / $173.78 / $204.17
| Professional | | $120.23 | $173.78 | $204.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $104.71 / $131.83
| Professional | | $104.71 | $104.71 | $131.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $63.10 / $109.65 / $436.52
| Facility | | $63.10 | $109.65 | $436.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $63.10 / $154.88
| Professional | | $45.71 | $63.10 | $154.88 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $93.33 / $154.88
| Professional | | $45.71 | $93.33 | $154.88 |