- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.50 / $464.76 / $2,311.62
| Professional | | $371.50 | $464.76 | $2,311.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.25 / $769.25 / $769.25
| Facility | | $769.25 | $769.25 | $769.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.71 / $769.25 / $2,172.48
| Professional | | $483.71 | $769.25 | $2,172.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.53 / $493.70 / $945.90
| Facility | | $335.53 | $493.70 | $945.90 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $427.94 / $636.12 / $971.60
| Professional | | $427.94 | $636.12 | $971.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $646.30 / $773.02 / $951.66
| Professional | | $646.30 | $773.02 | $951.66 |