- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.28 / $699.94 / $2,480.34
| Professional | | $528.28 | $699.94 | $2,480.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $801.32 / $801.32 / $801.32
| Facility | | $801.32 | $801.32 | $801.32 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $373.16 / $752.53 / $801.32
| Professional | | $373.16 | $752.53 | $801.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.34 / $496.82 / $797.58
| Facility | | $395.34 | $496.82 | $797.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $477.59 / $759.13 / $1,042.30
| Professional | | $477.59 | $759.13 | $1,042.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $644.96 / $753.21 / $887.71
| Professional | | $644.96 | $753.21 | $887.71 |