- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.03 / $338.84 / $457.09
| Professional | | $309.03 | $338.84 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $870.96 / $1,348.96 / $1,621.81
| Professional | | $870.96 | $1,348.96 | $1,621.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $549.54 / $1,047.13
| Professional | | $331.13 | $549.54 | $1,047.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,288.25 / $5,370.32
| Facility | | $1,258.93 | $1,288.25 | $5,370.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $575.44 / $1,202.26
| Professional | | $371.54 | $575.44 | $1,202.26 |