- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.27 / $268.86 / $518.23
| Professional | | $257.27 | $268.86 | $518.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.46 / $215.84 / $319.44
| Professional | | $183.46 | $215.84 | $319.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,144.71 / $1,144.71 / $1,144.71
| Facility | | $1,144.71 | $1,144.71 | $1,144.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.94 / $372.67 / $675.49
| Professional | | $254.94 | $372.67 | $675.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.04 / $362.15 / $622.14
| Professional | | $204.04 | $362.15 | $622.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.27 / $257.27 / $510.12
| Professional | | $257.27 | $257.27 | $510.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.14 / $439.55 / $568.39
| Professional | | $303.14 | $439.55 | $568.39 |