- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $239.88 / $245.47 / $2,089.30
| Facility | | $239.88 | $245.47 | $2,089.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $281.84
| Professional | | $245.47 | $245.47 | $281.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $302.00 / $724.44
| Facility | | $245.47 | $302.00 | $724.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $436.52
| Professional | | $125.89 | $245.47 | $436.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $229.09 / $245.47 / $446.68
| Facility | | $229.09 | $245.47 | $446.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.47 / $245.47 / $316.23
| Professional | | $245.47 | $245.47 | $316.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $407.38 / $1,047.13
| Facility | | $245.47 | $407.38 | $1,047.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $125.89 / $245.47 / $269.15
| Professional | | $125.89 | $245.47 | $269.15 |