- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $210.65 / $1,103.81 / $1,447.17
| Facility | | $210.65 | $1,103.81 | $1,447.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.65 / $210.65 / $210.65
| Professional | | $210.65 | $210.65 | $210.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.44 / $152.66 / $478.50
| Facility | | $148.44 | $152.66 | $478.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.71 / $198.41 / $319.32
| Professional | | $104.71 | $198.41 | $319.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.66 / $199.71 / $748.48
| Facility | | $173.66 | $199.71 | $748.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.45 / $235.90 / $296.92
| Professional | | $187.45 | $235.90 | $296.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $104.20 / $145.69 / $277.49
| Professional | | $104.20 | $145.69 | $277.49 |