- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $128.82 / $181.97 / $263.03
| Professional | | $128.82 | $181.97 | $263.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.55 / $190.55 / $190.55
| Professional | | $190.55 | $190.55 | $190.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $181.97 / $562.34
| Facility | | $181.97 | $181.97 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.83 / $131.83 / $398.11
| Professional | | $131.83 | $131.83 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $97.72 / $169.82 / $389.05
| Facility | | $97.72 | $169.82 | $389.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.50 / $134.90 / $218.78
| Professional | | $95.50 | $134.90 | $218.78 |