- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $819.89 / $938.01 / $958.85
| Professional | | $819.89 | $938.01 | $958.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,518.00 / $6,548.00 / $10,517.23
| Facility | | $3,518.00 | $6,548.00 | $10,517.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.16 / $629.24 / $951.12
| Professional | | $535.16 | $629.24 | $951.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,806.27 / $3,806.27 / $3,806.27
| Facility | | $3,806.27 | $3,806.27 | $3,806.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $520.52 / $786.84 / $1,295.60
| Professional | | $520.52 | $786.84 | $1,295.60 |