- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $215.30 / $310.80 / $386.45
| Professional | | $215.30 | $310.80 | $386.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,074.59 / $3,074.59 / $3,702.27
| Facility | | $3,074.59 | $3,074.59 | $3,702.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $377.12 / $796.91
| Professional | | $282.58 | $377.12 | $796.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $377.12 / $796.91
| Professional | | $282.58 | $377.12 | $796.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $296.52 / $346.44 / $978.12
| Professional | | $296.52 | $346.44 | $978.12 |