- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.55 / $140.72 / $199.36
| Professional | | $105.55 | $140.72 | $199.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.31 / $211.47 / $211.47
| Professional | | $190.31 | $211.47 | $211.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.36 / $232.19 / $293.00
| Professional | | $89.36 | $232.19 | $293.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $46.97 / $122.44 / $258.30
| Facility | | $46.97 | $122.44 | $258.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.44 / $197.02 / $1,157.24
| Professional | | $84.44 | $197.02 | $1,157.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $35.50 / $140.72 / $200.96
| Professional | | $35.50 | $140.72 | $200.96 |