- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $183.43 / $381.25 / $497.89
| Professional | | $183.43 | $381.25 | $497.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.43 / $366.87 / $592.30
| Professional | | $246.43 | $366.87 | $592.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.23 / $213.23 / $213.23
| Professional | | $213.23 | $213.23 | $213.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.10 / $497.89 / $746.84
| Facility | | $377.10 | $497.89 | $746.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.75 / $761.48 / $1,288.65
| Professional | | $585.75 | $761.48 | $1,288.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $200.31 / $221.62 / $317.95
| Professional | | $200.31 | $221.62 | $317.95 |