- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $210.36 / $920.12 / $1,690.80
| Professional | | $210.36 | $920.12 | $1,690.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.78 / $603.27 / $1,346.27
| Facility | | $195.78 | $603.27 | $1,346.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.00 / $836.00 / $2,108.69
| Professional | | $194.00 | $836.00 | $2,108.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.18 / $627.49 / $836.00
| Facility | | $484.18 | $627.49 | $836.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $194.00 / $627.49 / $847.77
| Professional | | $194.00 | $627.49 | $847.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $5.00 / $1,280.80
| Professional | | $5.00 | $5.00 | $1,280.80 |