- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.78 / $129.80 / $143.83
| Professional | | $122.78 | $129.80 | $143.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $175.40 / $206.59 / $224.51
| Facility | | $175.40 | $206.59 | $224.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.55 / $131.55 / $214.32
| Professional | | $131.55 | $131.55 | $214.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $518.94 / $518.94 / $518.94
| Facility | | $518.94 | $518.94 | $518.94 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $90.02 / $240.89 / $490.18
| Professional | | $90.02 | $240.89 | $490.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.67 / $105.24 / $252.98
| Professional | | $73.67 | $105.24 | $252.98 |