- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.21 / $245.47 / $245.47
| Professional | | $186.21 | $245.47 | $245.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.80 / $213.80 / $213.80
| Professional | | $213.80 | $213.80 | $213.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $457.09
| Facility | | $147.91 | $234.42 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.91 / $234.42 / $457.09
| Professional | | $147.91 | $234.42 | $457.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $131.83 / $173.78 / $323.59
| Facility | | $131.83 | $173.78 | $323.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $234.42
| Professional | | $131.83 | $131.83 | $234.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $89.13 / $120.23 / $251.19
| Professional | | $89.13 | $120.23 | $251.19 |