- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.13 / $195.61 / $205.16
| Professional | | $151.13 | $195.61 | $205.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.07 / $660.58 / $782.05
| Facility | | $489.07 | $660.58 | $782.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.05 / $225.94 / $312.83
| Professional | | $192.05 | $225.94 | $312.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.09 / $203.51 / $203.51
| Facility | | $200.09 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.56 / $203.51 / $203.51
| Professional | | $148.56 | $203.51 | $203.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.44 / $216.64 / $287.63
| Professional | | $162.44 | $216.64 | $287.63 |