- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $293.38 / $378.35 / $1,434.29
| Professional | | $293.38 | $378.35 | $1,434.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $428.53 / $428.53 / $428.53
| Professional | | $428.53 | $428.53 | $428.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.53 / $428.53 / $428.53
| Facility | | $428.53 | $428.53 | $428.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $234.52 / $428.53 / $472.00
| Professional | | $234.52 | $428.53 | $472.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.64 / $291.01 / $435.65
| Facility | | $211.64 | $291.01 | $435.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.36 / $428.53 / $567.70
| Professional | | $262.36 | $428.53 | $567.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $388.62 / $458.29 / $513.91
| Professional | | $388.62 | $458.29 | $513.91 |