- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $206.43 / $211.39 / $351.70
| Professional | | $206.43 | $211.39 | $351.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.43 / $435.06 / $786.57
| Facility | | $120.43 | $435.06 | $786.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.08 / $401.44 / $546.96
| Professional | | $301.08 | $401.44 | $546.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.27 / $294.27 / $294.27
| Facility | | $294.27 | $294.27 | $294.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.82 / $214.82 / $544.88
| Professional | | $214.82 | $214.82 | $544.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $135.22 / $306.51 / $2,188.60
| Facility | | $135.22 | $306.51 | $2,188.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.32 / $209.46 / $322.77
| Professional | | $189.32 | $209.46 | $322.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3.35 / $292.60 / $322.77
| Facility | | $3.35 | $292.60 | $322.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $189.32 / $209.46 / $315.52
| Professional | | $189.32 | $209.46 | $315.52 |