- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $288.40 / $363.08 / $645.65
| Professional | | $288.40 | $363.08 | $645.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Facility | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $562.34 / $562.34 / $562.34
| Professional | | $562.34 | $562.34 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $489.78 / $489.78 / $660.69
| Facility | | $489.78 | $489.78 | $660.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $363.08 / $562.34
| Professional | | $363.08 | $363.08 | $562.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.80 / $380.19 / $457.09
| Facility | | $213.80 | $380.19 | $457.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $288.40 / $436.52
| Professional | | $257.04 | $288.40 | $436.52 |