- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.07 / $200.86 / $269.87
| Professional | | $151.07 | $200.86 | $269.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.75 / $271.75 / $271.75
| Professional | | $271.75 | $271.75 | $271.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.62 / $267.62 / $269.81
| Facility | | $267.62 | $267.62 | $269.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.48 / $267.62 / $302.31
| Professional | | $227.48 | $267.62 | $302.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.28 / $350.55 / $402.45
| Professional | | $181.28 | $350.55 | $402.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $159.34 / $239.02 / $265.58
| Professional | | $159.34 | $239.02 | $265.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.56 / $192.40 / $297.72
| Professional | | $152.56 | $192.40 | $297.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.27 / $296.27 / $296.27
| Professional | | $296.27 | $296.27 | $296.27 |