- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.50 / $504.50 / $504.50
| Facility | | $504.50 | $504.50 | $504.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $158.63 / $214.18 / $598.50
| Professional | | $158.63 | $214.18 | $598.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $160.97 / $305.81 / $441.77
| Professional | | $160.97 | $305.81 | $441.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.34 / $247.71 / $542.95
| Professional | | $181.34 | $247.71 | $542.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $220.98 / $274.79 / $414.58
| Professional | | $220.98 | $274.79 | $414.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.45 / $323.45 / $336.70
| Professional | | $315.45 | $323.45 | $336.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $169.88 / $238.16 / $519.08
| Professional | | $169.88 | $238.16 | $519.08 |