- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $278.01 / $278.01 / $278.01
| Facility | | $278.01 | $278.01 | $278.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.40 / $157.86 / $215.49
| Professional | | $118.40 | $157.86 | $215.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.17 / $235.79 / $247.55
| Professional | | $208.17 | $235.79 | $247.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.09 / $227.25 / $304.72
| Professional | | $147.09 | $227.25 | $304.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.17 / $252.30 / $483.97
| Professional | | $169.17 | $252.30 | $483.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $32.34
| Professional | | $32.34 | $32.34 | $32.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.13 / $190.12 / $335.31
| Professional | | $154.13 | $190.12 | $335.31 |