- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $161.76 / $161.76 / $205.36
| Facility | | $161.76 | $161.76 | $205.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $139.69 / $170.53 / $231.04
| Professional | | $139.69 | $170.53 | $231.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.17 / $338.39 / $602.34
| Facility | | $301.17 | $338.39 | $602.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $183.43 / $260.52
| Professional | | $183.43 | $183.43 | $260.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $188.19 / $188.19 / $207.77
| Facility | | $188.19 | $188.19 | $207.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.38 / $188.19 / $200.62
| Professional | | $137.38 | $188.19 | $200.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $124.48 / $150.25 / $231.53
| Professional | | $124.48 | $150.25 | $231.53 |