- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $431.81 / $575.50 / $2,121.98
| Professional | | $431.81 | $575.50 | $2,121.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.20 / $656.20 / $656.20
| Facility | | $656.20 | $656.20 | $656.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.92 / $656.20 / $671.63
| Professional | | $325.92 | $656.20 | $671.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $326.02 / $411.83 / $656.20
| Facility | | $326.02 | $411.83 | $656.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.76 / $652.97 / $847.70
| Professional | | $391.76 | $652.97 | $847.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $544.26 / $648.48 / $733.94
| Professional | | $544.26 | $648.48 | $733.94 |