- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.13 / $267.36 / $267.36
| Professional | | $131.13 | $267.36 | $267.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $185.61 / $185.61 / $208.72
| Facility | | $185.61 | $185.61 | $208.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $135.50 / $185.61 / $197.87
| Professional | | $135.50 | $185.61 | $197.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $80.38 / $227.87 / $305.33
| Facility | | $80.38 | $227.87 | $305.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $274.81 / $290.07 / $305.33
| Professional | | $274.81 | $290.07 | $305.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $225.34 / $268.36
| Professional | | $30.00 | $225.34 | $268.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.36 / $298.18 / $447.27
| Facility | | $267.36 | $298.18 | $447.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.74 / $213.74 / $320.61
| Professional | | $213.74 | $213.74 | $320.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.26 / $195.26 / $195.26
| Facility | | $195.26 | $195.26 | $195.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.13 / $124.52 / $197.48
| Professional | | $115.13 | $124.52 | $197.48 |