- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.03 / $103.03 / $129.29
| Professional | | $103.03 | $103.03 | $129.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.93 / $417.52 / $503.96
| Professional | | $279.93 | $417.52 | $503.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $638.07 / $638.07 / $801.00
| Professional | | $638.07 | $638.07 | $801.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $228.74 / $228.74 / $658.49
| Facility | | $228.74 | $228.74 | $658.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.00 / $693.25 / $693.25
| Professional | | $602.00 | $693.25 | $693.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $60.00 / $85.00
| Professional | | $60.00 | $60.00 | $85.00 |