- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.66 / $195.31 / $214.85
| Professional | | $142.66 | $195.31 | $214.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.16 / $214.16 / $291.73
| Facility | | $214.16 | $214.16 | $291.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.34 / $156.34 / $291.73
| Professional | | $156.34 | $156.34 | $291.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.08 / $234.08 / $234.08
| Professional | | $234.08 | $234.08 | $234.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.25 / $154.24 / $154.24
| Facility | | $0.25 | $154.24 | $154.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $134.28 / $172.94 / $271.32
| Professional | | $134.28 | $172.94 | $271.32 |