- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $232.19 / $292.20 / $315.18
| Professional | | $232.19 | $292.20 | $315.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $751.36 / $1,014.79 / $1,201.39
| Facility | | $751.36 | $1,014.79 | $1,201.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.38 / $279.27 / $467.06
| Professional | | $237.38 | $279.27 | $467.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $388.32 / $388.32 / $388.32
| Facility | | $388.32 | $388.32 | $388.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.07 / $388.32 / $388.32
| Professional | | $330.07 | $388.32 | $388.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $239.62 / $338.74 / $441.87
| Professional | | $239.62 | $338.74 | $441.87 |