- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $233.53 / $233.53 / $280.24
| Facility | | $233.53 | $233.53 | $280.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.21 / $185.63 / $233.53
| Professional | | $181.21 | $185.63 | $233.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.72 / $414.72 / $491.61
| Facility | | $414.72 | $414.72 | $491.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.25 / $221.25 / $233.13
| Professional | | $221.25 | $221.25 | $233.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.28 / $228.28 / $228.28
| Facility | | $228.28 | $228.28 | $228.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $166.64 / $166.64 / $243.36
| Professional | | $166.64 | $166.64 | $243.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $335.79 / $335.79 / $1,036.42
| Professional | | $335.79 | $335.79 | $1,036.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $137.94 / $206.90 / $330.45
| Professional | | $137.94 | $206.90 | $330.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.62 / $341.68 / $434.87
| Professional | | $310.62 | $341.68 | $434.87 |