- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $121.97 / $430.17 / $531.98
| Facility | | $121.97 | $430.17 | $531.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.97 / $87.81 / $121.97
| Professional | | $77.97 | $87.81 | $121.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.33 / $123.48 / $168.19
| Professional | | $74.33 | $123.48 | $168.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $323.94 / $339.34 / $358.00
| Facility | | $323.94 | $339.34 | $358.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.51 / $144.10 / $223.81
| Professional | | $99.51 | $144.10 | $223.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.21 / $174.21 / $174.21
| Professional | | $174.21 | $174.21 | $174.21 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $92.75 / $137.91 / $254.68
| Professional | | $92.75 | $137.91 | $254.68 |