- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.25 / $203.84 / $354.50
| Facility | | $177.25 | $203.84 | $354.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $138.26 / $203.84 / $203.84
| Professional | | $138.26 | $203.84 | $203.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.15 / $191.92 / $258.19
| Facility | | $158.15 | $191.92 | $258.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $112.28 / $177.25 / $209.16
| Professional | | $112.28 | $177.25 | $209.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $130.38 / $152.72 / $555.54
| Facility | | $130.38 | $152.72 | $555.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.25 / $136.28 / $988.28
| Professional | | $78.25 | $136.28 | $988.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.45 / $74.45 / $241.81
| Professional | | $74.45 | $74.45 | $241.81 |