- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.25 / $360.83 / $1,857.34
| Professional | | $310.25 | $360.83 | $1,857.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.40 / $660.40 / $660.40
| Facility | | $660.40 | $660.40 | $660.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $319.12 / $594.36 / $664.06
| Professional | | $319.12 | $594.36 | $664.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $328.60 / $443.62 / $660.40
| Facility | | $328.60 | $443.62 | $660.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.91 / $595.58 / $915.13
| Professional | | $375.91 | $595.58 | $915.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.13 / $632.24 / $733.93
| Professional | | $567.13 | $632.24 | $733.93 |