- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.84 / $323.59 / $1,071.52
| Professional | | $281.84 | $323.59 | $1,071.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $812.83 / $1,023.29 / $1,230.27
| Facility | | $812.83 | $1,023.29 | $1,230.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.42 / $275.42 / $660.69
| Professional | | $234.42 | $275.42 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,230.27 / $1,513.56 / $2,187.76
| Facility | | $1,230.27 | $1,513.56 | $2,187.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $707.95 / $724.44
| Professional | | $380.19 | $707.95 | $724.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,148.15 / $1,148.15 / $1,148.15
| Facility | | $1,148.15 | $1,148.15 | $1,148.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $263.03 / $549.54
| Professional | | $114.82 | $263.03 | $549.54 |