- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $566.08 / $752.48 / $4,008.92
| Professional | | $566.08 | $752.48 | $4,008.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $938.43 / $1,266.88 / $3,566.03
| Facility | | $938.43 | $1,266.88 | $3,566.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.80 / $892.85 / $2,106.94
| Professional | | $336.80 | $892.85 | $2,106.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $505.63 / $1,266.88 / $1,848.71
| Facility | | $505.63 | $1,266.88 | $1,848.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $668.35 / $946.85 / $1,679.07
| Professional | | $668.35 | $946.85 | $1,679.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $790.46 / $983.79 / $1,485.58
| Professional | | $790.46 | $983.79 | $1,485.58 |