- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.82 / $309.03 / $537.03
| Professional | | $169.82 | $309.03 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $141.25 / $245.47 / $316.23
| Professional | | $141.25 | $245.47 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.19 / $371.54 / $691.83
| Professional | | $251.19 | $371.54 | $691.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $354.81 / $630.96
| Professional | | $173.78 | $354.81 | $630.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.98 / $426.58 / $812.83
| Professional | | $194.98 | $426.58 | $812.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.83 / $316.23 / $562.34
| Professional | | $177.83 | $316.23 | $562.34 |