- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $523.87 / $523.87 / $553.80
| Professional | | $523.87 | $523.87 | $553.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $0.02 / $1,534.62 / $1,732.52
| Facility | | $0.02 | $1,534.62 | $1,732.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $991.62 / $991.62 / $991.62
| Professional | | $991.62 | $991.62 | $991.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,212.96 / $2,212.96 / $2,212.96
| Facility | | $2,212.96 | $2,212.96 | $2,212.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $314.32 / $449.03 / $1,079.40
| Professional | | $314.32 | $449.03 | $1,079.40 |