- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $226.18 / $364.56
| Professional | | $203.58 | $226.18 | $364.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.47 / $230.47 / $552.11
| Facility | | $230.47 | $230.47 | $552.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.06 / $231.61 / $386.02
| Facility | | $192.06 | $231.61 | $386.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Professional | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $192.06 / $231.61 / $386.02
| Facility | | $192.06 | $231.61 | $386.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $203.58 / $203.58 / $203.58
| Professional | | $203.58 | $203.58 | $203.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.40 / $215.79 / $313.17
| Professional | | $193.40 | $215.79 | $313.17 |