- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.48 / $242.81 / $281.62
| Facility | | $221.48 | $242.81 | $281.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.25 / $225.63 / $317.29
| Professional | | $186.25 | $225.63 | $317.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.43 / $472.94 / $778.12
| Facility | | $381.43 | $472.94 | $778.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.41 / $231.73 / $333.78
| Professional | | $230.41 | $231.73 | $333.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $248.05 / $248.05 / $248.05
| Facility | | $248.05 | $248.05 | $248.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.08 / $248.05 / $300.00
| Professional | | $181.08 | $248.05 | $300.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.15 / $193.63 / $315.29
| Professional | | $169.15 | $193.63 | $315.29 |