- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.24 / $259.05 / $461.62
| Professional | | $207.24 | $259.05 | $461.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $220.11 / $355.62 / $702.77
| Facility | | $220.11 | $355.62 | $702.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $446.00 / $1,021.00 / $1,149.42
| Professional | | $446.00 | $1,021.00 | $1,149.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $393.00 / $393.00 / $393.00
| Facility | | $393.00 | $393.00 | $393.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $190.09 / $337.55 / $400.86
| Professional | | $190.09 | $337.55 | $400.86 |