- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.03 / $588.84 / $1,023.29
| Professional | | $537.03 | $588.84 | $1,023.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $1,380.38 / $1,380.38
| Facility | | $1,380.38 | $1,380.38 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $2,041.74 / $2,041.74
| Professional | | $1,348.96 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $676.08 / $1,071.52 / $1,659.59
| Professional | | $676.08 | $1,071.52 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,380.38 / $2,630.27 / $10,471.29
| Facility | | $1,380.38 | $2,630.27 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.96 / $1,047.13 / $2,238.72
| Professional | | $630.96 | $1,047.13 | $2,238.72 |