- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $407.38 / $1,071.52
| Professional | | $338.84 | $407.38 | $1,071.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $501.19 / $741.31
| Professional | | $380.19 | $501.19 | $741.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.19 / $501.19 / $501.19
| Facility | | $501.19 | $501.19 | $501.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $426.58 / $426.58 / $501.19
| Professional | | $426.58 | $426.58 | $501.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $467.74 / $467.74 / $537.03
| Facility | | $467.74 | $467.74 | $537.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $588.84
| Professional | | $331.13 | $446.68 | $588.84 |