- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $144.54 / $181.97 / $288.40
| Professional | | $144.54 | $181.97 | $288.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $257.04 / $257.04
| Professional | | $257.04 | $257.04 | $257.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.78 / $218.78 / $549.54
| Facility | | $218.78 | $218.78 | $549.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.18 / $162.18 / $398.11
| Professional | | $162.18 | $162.18 | $398.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.17 / $229.09 / $416.87
| Facility | | $204.17 | $229.09 | $416.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $158.49 / $234.42
| Professional | | $102.33 | $158.49 | $234.42 |