- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $77.40 / $105.78 / $517.86
| Professional | | $77.40 | $105.78 | $517.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $19.63 / $19.63 / $19.63
| Professional | | $19.63 | $19.63 | $19.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.30 / $206.72 / $206.72
| Facility | | $120.30 | $206.72 | $206.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.30 / $172.01 / $206.72
| Professional | | $120.30 | $172.01 | $206.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $84.06 / $169.02 / $249.07
| Facility | | $84.06 | $169.02 | $249.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.30 / $172.01 / $206.72
| Professional | | $120.30 | $172.01 | $206.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $84.98 / $84.98 / $103.51
| Professional | | $84.98 | $84.98 | $103.51 |