- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $539.87 / $717.51 / $2,648.16
| Professional | | $539.87 | $717.51 | $2,648.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $816.57 / $816.57 / $816.57
| Facility | | $816.57 | $816.57 | $816.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $415.45 / $816.57 / $837.50
| Professional | | $415.45 | $816.57 | $837.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.03 / $556.91 / $816.57
| Facility | | $405.03 | $556.91 | $816.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $489.13 / $815.27 / $1,058.40
| Professional | | $489.13 | $815.27 | $1,058.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $656.53 / $812.00 / $1,247.00
| Professional | | $656.53 | $812.00 | $1,247.00 |