- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $174.51 / $191.89 / $246.01
| Professional | | $174.51 | $191.89 | $246.01 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.89 / $282.89 / $282.89
| Professional | | $282.89 | $282.89 | $282.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.60 / $104.60 / $104.60
| Professional | | $104.60 | $104.60 | $104.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.60 / $205.32 / $309.31
| Facility | | $180.60 | $205.32 | $309.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $85.13 / $128.94 / $1,394.74
| Professional | | $85.13 | $128.94 | $1,394.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $72.48 / $116.54 / $163.22
| Professional | | $72.48 | $116.54 | $163.22 |