- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $262.68 / $465.31 / $2,412.86
| Professional | | $262.68 | $465.31 | $2,412.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.07 / $628.07 / $628.07
| Facility | | $628.07 | $628.07 | $628.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.68 / $424.84 / $843.31
| Professional | | $178.68 | $424.84 | $843.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $628.07 / $628.07 / $628.07
| Facility | | $628.07 | $628.07 | $628.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.68 / $424.84 / $843.31
| Professional | | $178.68 | $424.84 | $843.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.61 / $225.15 / $866.98
| Professional | | $157.61 | $225.15 | $866.98 |