- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $86.37 / $450.23 / $3,376.30
| Facility | | $86.37 | $450.23 | $3,376.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $407.72 / $450.23 / $484.86
| Professional | | $407.72 | $450.23 | $484.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $495.00 / $550.00 / $907.50
| Professional | | $495.00 | $550.00 | $907.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $538.89 / $1,334.90 / $2,301.25
| Professional | | $538.89 | $1,334.90 | $2,301.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $509.10 / $1,104.39 / $1,104.39
| Professional | | $509.10 | $1,104.39 | $1,104.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.82 / $591.25 / $1,333.98
| Professional | | $352.82 | $591.25 | $1,333.98 |