- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $326.36 / $326.36
| Professional | | $310.38 | $326.36 | $326.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,043.93 / $1,441.98 / $2,366.60
| Facility | | $1,043.93 | $1,441.98 | $2,366.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.38 / $332.22 / $481.98
| Professional | | $282.38 | $332.22 | $481.98 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.02 / $462.64 / $598.91
| Professional | | $320.02 | $462.64 | $598.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.68 / $354.83 / $665.74
| Professional | | $306.68 | $354.83 | $665.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.38 / $326.36 / $409.81
| Professional | | $310.38 | $326.36 | $409.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $227.36 / $390.24 / $518.54
| Professional | | $227.36 | $390.24 | $518.54 |