- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $209.05 / $370.31 / $1,555.42
| Professional | | $209.05 | $370.31 | $1,555.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.89 / $404.89 / $404.89
| Facility | | $404.89 | $404.89 | $404.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.33 / $338.40 / $604.10
| Professional | | $142.33 | $338.40 | $604.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.89 / $404.89 / $404.89
| Facility | | $404.89 | $404.89 | $404.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $142.33 / $338.40 / $604.10
| Professional | | $142.33 | $338.40 | $604.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $105.66 / $330.01 / $558.89
| Professional | | $105.66 | $330.01 | $558.89 |