- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.76 / $317.99 / $361.48
| Professional | | $190.76 | $317.99 | $361.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $294.77 / $432.34 / $432.34
| Professional | | $294.77 | $432.34 | $432.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $175.28 / $175.28 / $175.28
| Professional | | $175.28 | $175.28 | $175.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $619.47 / $741.30 / $1,957.92
| Facility | | $619.47 | $741.30 | $1,957.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,424.76 / $2,424.76 / $2,781.83
| Professional | | $2,424.76 | $2,424.76 | $2,781.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $121.45 / $177.05 / $210.10
| Professional | | $121.45 | $177.05 | $210.10 |