- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.33 / $281.00 / $286.20
| Facility | | $264.33 | $281.00 | $286.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $255.71 / $274.14 / $321.82
| Professional | | $255.71 | $274.14 | $321.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $33.36 / $57.81 / $59.81
| Facility | | $33.36 | $57.81 | $59.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.31 / $252.91 / $258.47
| Professional | | $53.31 | $252.91 | $258.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $762.54 / $971.89 / $1,755.95
| Facility | | $762.54 | $971.89 | $1,755.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $22.70 / $22.70 / $22.70
| Professional | | $22.70 | $22.70 | $22.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $258.47 / $258.47 / $258.47
| Professional | | $258.47 | $258.47 | $258.47 |