- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $262.22 / $437.03 / $1,101.30
| Facility | | $262.22 | $437.03 | $1,101.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.22 / $262.22 / $297.18
| Professional | | $262.22 | $262.22 | $297.18 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.80 / $461.50 / $688.75
| Professional | | $181.80 | $461.50 | $688.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.34 / $1,660.70 / $1,660.70
| Facility | | $608.34 | $1,660.70 | $1,660.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,748.10 / $1,748.10 / $2,622.15
| Professional | | $1,748.10 | $1,748.10 | $2,622.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $146.84 / $209.77 / $349.62
| Professional | | $146.84 | $209.77 | $349.62 |