- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.78 / $126.78 / $166.12
| Facility | | $126.78 | $126.78 | $166.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.15 / $130.66 / $202.27
| Professional | | $105.15 | $130.66 | $202.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $268.30 / $329.92 / $421.52
| Professional | | $268.30 | $329.92 | $421.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.88 / $181.45 / $230.63
| Professional | | $142.88 | $181.45 | $230.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.78 / $183.93 / $286.07
| Facility | | $126.78 | $183.93 | $286.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.88 / $312.16 / $828.70
| Professional | | $159.88 | $312.16 | $828.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.26 / $295.48 / $413.64
| Professional | | $143.26 | $295.48 | $413.64 |