- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $385.15 / $423.83 / $529.79
| Professional | | $385.15 | $423.83 | $529.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $302.62 / $415.41 / $549.13
| Facility | | $302.62 | $415.41 | $549.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,154.00 / $2,154.00 / $2,154.00
| Professional | | $2,154.00 | $2,154.00 | $2,154.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.83 / $373.00 / $373.00
| Facility | | $309.83 | $373.00 | $373.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $309.83 / $387.00 / $414.80
| Professional | | $309.83 | $387.00 | $414.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.52 / $352.76 / $358.66
| Professional | | $260.52 | $352.76 | $358.66 |