- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $182.29 / $275.02 / $366.51
| Professional | | $182.29 | $275.02 | $366.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $783.80 / $783.80 / $1,003.84
| Facility | | $783.80 | $783.80 | $1,003.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $312.19 / $379.05 / $1,115.70
| Professional | | $312.19 | $379.05 | $1,115.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $236.65 / $379.09 / $1,020.91
| Professional | | $236.65 | $379.09 | $1,020.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.34 / $389.75 / $1,020.91
| Professional | | $245.34 | $389.75 | $1,020.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.14 / $386.72 / $1,124.23
| Professional | | $280.14 | $386.72 | $1,124.23 |