- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.00 / $303.00 / $326.93
| Professional | | $102.00 | $303.00 | $326.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.34 / $1,052.58 / $1,246.14
| Facility | | $779.34 | $1,052.58 | $1,246.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.02 / $360.03 / $498.47
| Professional | | $306.02 | $360.03 | $498.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $315.25 / $315.25 / $315.25
| Facility | | $315.25 | $315.25 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $230.13 / $315.25 / $315.25
| Professional | | $230.13 | $315.25 | $315.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.32 / $274.99 / $458.32
| Professional | | $213.32 | $274.99 | $458.32 |