- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $100.63 / $129.81 / $153.81
| Professional | | $100.63 | $129.81 | $153.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $136.56 / $136.56 / $206.27
| Professional | | $136.56 | $136.56 | $206.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $76.63 / $166.40 / $327.90
| Professional | | $76.63 | $166.40 | $327.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $111.70 / $148.53 / $230.51
| Facility | | $111.70 | $148.53 | $230.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.25 / $180.91 / $1,038.57
| Professional | | $86.25 | $180.91 | $1,038.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $86.25 / $105.36 / $230.00
| Professional | | $86.25 | $105.36 | $230.00 |