- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.13 / $280.22 / $1,052.97
| Professional | | $162.13 | $280.22 | $1,052.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $357.54 / $357.54 / $357.54
| Facility | | $357.54 | $357.54 | $357.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $204.04 / $334.23 / $564.17
| Professional | | $204.04 | $334.23 | $564.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.96 / $277.85 / $396.35
| Facility | | $177.96 | $277.85 | $396.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $251.28 / $409.06 / $617.38
| Professional | | $251.28 | $409.06 | $617.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.31 / $502.87 / $574.71
| Professional | | $426.31 | $502.87 | $574.71 |