- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.41 / $227.24 / $230.12
| Professional | | $167.41 | $227.24 | $230.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $541.72 / $731.68 / $866.23
| Facility | | $541.72 | $731.68 | $866.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.15 / $201.35 / $336.76
| Professional | | $171.15 | $201.35 | $336.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.62 / $305.27 / $305.27
| Facility | | $221.62 | $305.27 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $222.85 / $305.27 / $305.27
| Professional | | $222.85 | $305.27 | $305.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.76 / $244.23 / $318.58
| Professional | | $172.76 | $244.23 | $318.58 |