- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $164.26 / $334.30 / $577.35
| Professional | | $164.26 | $334.30 | $577.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $139.78 / $267.27 / $295.25
| Facility | | $139.78 | $267.27 | $295.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.79 / $575.40 / $575.40
| Professional | | $407.79 | $575.40 | $575.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.18 / $155.00 / $188.62
| Facility | | $150.18 | $155.00 | $188.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.63 / $188.62 / $256.27
| Professional | | $137.63 | $188.62 | $256.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.90 / $262.00 / $334.20
| Professional | | $227.90 | $262.00 | $334.20 |