- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.32 / $207.48 / $245.10
| Facility | | $138.32 | $207.48 | $245.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $115.34 / $176.53 / $213.47
| Professional | | $115.34 | $176.53 | $213.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.83 / $265.83 / $265.83
| Facility | | $265.83 | $265.83 | $265.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $152.76 / $202.19 / $202.19
| Professional | | $152.76 | $202.19 | $202.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.11 / $253.15 / $314.52
| Professional | | $133.11 | $253.15 | $314.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $109.10 / $187.06 / $267.22
| Professional | | $109.10 | $187.06 | $267.22 |