- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $163.83 / $215.03 / $222.39
| Professional | | $163.83 | $215.03 | $222.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.16 / $716.06 / $847.73
| Facility | | $530.16 | $716.06 | $847.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.49 / $197.05 / $329.57
| Professional | | $167.49 | $197.05 | $329.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $216.88 / $227.07 / $227.07
| Facility | | $216.88 | $227.07 | $227.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $165.76 / $227.07 / $227.07
| Professional | | $165.76 | $227.07 | $227.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.38 / $187.07 / $311.79
| Professional | | $151.38 | $187.07 | $311.79 |