- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.17 / $193.27 / $260.13
| Professional | | $126.17 | $193.27 | $260.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.89 / $314.10 / $384.31
| Professional | | $263.89 | $314.10 | $384.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.52 / $209.52 / $290.14
| Facility | | $209.52 | $209.52 | $290.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.65 / $209.52 / $517.50
| Professional | | $31.65 | $209.52 | $517.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $43.06 / $43.06 / $43.06
| Professional | | $43.06 | $43.06 | $43.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.62 / $189.90 / $307.93
| Professional | | $128.62 | $189.90 | $307.93 |