- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.69 / $142.66 / $142.66
| Professional | | $102.69 | $142.66 | $142.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.04 / $270.83 / $502.02
| Facility | | $209.04 | $270.83 | $502.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $107.19 / $112.48 / $112.48
| Professional | | $107.19 | $112.48 | $112.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $110.15 / $110.15 / $172.73
| Facility | | $110.15 | $110.15 | $172.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $80.41 / $80.41 / $110.15
| Professional | | $80.41 | $80.41 | $110.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.29 / $190.29 / $190.29
| Professional | | $190.29 | $190.29 | $190.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.33 / $142.66 / $142.66
| Professional | | $132.33 | $142.66 | $142.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $78.17 / $117.25 / $278.94
| Professional | | $78.17 | $117.25 | $278.94 |