- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.45 / $147.74 / $354.47
| Professional | | $117.45 | $147.74 | $354.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.81 / $205.46 / $276.20
| Professional | | $134.81 | $205.46 | $276.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $125.28 / $182.85 / $239.02
| Facility | | $125.28 | $182.85 | $239.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.22 / $228.24 / $253.60
| Professional | | $209.22 | $228.24 | $253.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.34 / $32.34 / $235.38
| Professional | | $32.34 | $32.34 | $235.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.03 / $196.51 / $244.26
| Professional | | $167.03 | $196.51 | $244.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.56 / $190.12 / $244.33
| Professional | | $142.56 | $190.12 | $244.33 |