- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $131.16 / $158.97 / $178.05
| Professional | | $131.16 | $158.97 | $178.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.46 / $573.29 / $678.71
| Facility | | $424.46 | $573.29 | $678.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.68 / $169.04 / $271.49
| Professional | | $143.68 | $169.04 | $271.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $165.40 / $165.40 / $173.64
| Facility | | $165.40 | $165.40 | $173.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $120.74 / $165.40 / $165.40
| Professional | | $120.74 | $165.40 | $165.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $117.27 / $149.77 / $249.62
| Professional | | $117.27 | $149.77 | $249.62 |