- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $53.32 / $74.81 / $312.18
| Professional | | $53.32 | $74.81 | $312.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,022.11 / $2,022.11 / $2,184.59
| Facility | | $2,022.11 | $2,022.11 | $2,184.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $829.62 / $829.62 / $829.62
| Professional | | $829.62 | $829.62 | $829.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.44 / $131.69 / $544.42
| Professional | | $82.44 | $131.69 | $544.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.44 / $264.05 / $544.42
| Professional | | $82.44 | $264.05 | $544.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $243.40 / $357.87 / $994.07
| Professional | | $243.40 | $357.87 | $994.07 |