- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.06 / $482.06 / $556.22
| Professional | | $482.06 | $482.06 | $556.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.14 / $501.14 / $726.06
| Facility | | $501.14 | $501.14 | $726.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.83 / $501.14 / $534.24
| Professional | | $365.83 | $501.14 | $534.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.14 / $501.14 / $726.06
| Facility | | $501.14 | $501.14 | $726.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.83 / $501.14 / $534.24
| Professional | | $365.83 | $501.14 | $534.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.56 / $585.16 / $1,142.00
| Professional | | $328.56 | $585.16 | $1,142.00 |