- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.22 / $1,329.77 / $1,329.77
| Professional | | $242.22 | $1,329.77 | $1,329.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $49.43 / $49.43 / $334.41
| Professional | | $49.43 | $49.43 | $334.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.02 / $402.33 / $1,132.48
| Facility | | $298.02 | $402.33 | $1,132.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.13 / $334.41 / $651.10
| Professional | | $152.13 | $334.41 | $651.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.02 / $402.33 / $1,132.48
| Facility | | $298.02 | $402.33 | $1,132.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $207.49 / $298.35 / $406.83
| Professional | | $207.49 | $298.35 | $406.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $192.58 / $197.25 / $407.54
| Professional | | $192.58 | $197.25 | $407.54 |