- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $259.62 / $259.62 / $1,337.58
| Professional | | $259.62 | $259.62 | $1,337.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.40 / $1,367.91 / $2,279.41
| Facility | | $348.40 | $1,367.91 | $2,279.41 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $290.68 / $422.80 / $842.96
| Professional | | $290.68 | $422.80 | $842.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.25 / $208.25 / $208.25
| Professional | | $208.25 | $208.25 | $208.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.15 / $463.60 / $2,169.65
| Facility | | $137.15 | $463.60 | $2,169.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.74 / $352.47 / $579.59
| Professional | | $231.74 | $352.47 | $579.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.92 / $352.47 / $627.26
| Professional | | $304.92 | $352.47 | $627.26 |