- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.37 / $800.84 / $1,456.67
| Facility | | $475.37 | $800.84 | $1,456.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.37 / $475.37 / $560.26
| Professional | | $475.37 | $475.37 | $560.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,058.40 / $1,058.40 / $1,058.40
| Professional | | $1,058.40 | $1,058.40 | $1,058.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.76 / $482.18 / $739.29
| Facility | | $382.76 | $482.18 | $739.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $368.47 / $510.11 / $2,343.00
| Professional | | $368.47 | $510.11 | $2,343.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.45 / $492.79 / $683.77
| Professional | | $360.45 | $492.79 | $683.77 |