- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.30 / $260.91 / $260.91
| Facility | | $184.30 | $260.91 | $260.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $184.30 / $184.30 / $184.30
| Professional | | $184.30 | $184.30 | $184.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.62 / $345.62 / $345.62
| Professional | | $345.62 | $345.62 | $345.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.71 / $347.71 / $347.71
| Professional | | $347.71 | $347.71 | $347.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.50 / $200.50 / $634.71
| Professional | | $200.50 | $200.50 | $634.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $126.46 / $211.51 / $397.33
| Professional | | $126.46 | $211.51 | $397.33 |