- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.16 / $183.68 / $241.84
| Professional | | $178.16 | $183.68 | $241.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $576.53 / $778.65 / $921.83
| Facility | | $576.53 | $778.65 | $921.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.16 / $229.60 / $368.75
| Professional | | $195.16 | $229.60 | $368.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $197.02 / $197.02 / $235.86
| Facility | | $197.02 | $197.02 | $235.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.82 / $197.02 / $197.02
| Professional | | $143.82 | $197.02 | $197.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.86 / $229.28 / $339.05
| Professional | | $183.86 | $229.28 | $339.05 |