- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $312.86 / $312.86 / $312.86
| Facility | | $312.86 | $312.86 | $312.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.46 / $317.02 / $390.19
| Professional | | $254.46 | $317.02 | $390.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $298.32 / $375.51 / $450.61
| Professional | | $298.32 | $375.51 | $450.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $307.55 / $307.55 / $307.55
| Facility | | $307.55 | $307.55 | $307.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $261.42 / $261.42 / $580.50
| Professional | | $261.42 | $261.42 | $580.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.08 / $2,352.03 / $2,378.23
| Facility | | $660.08 | $2,352.03 | $2,378.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $143.93 / $238.66 / $327.18
| Professional | | $143.93 | $238.66 | $327.18 |