- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $423.94 / $450.93 / $4,913.39
| Professional | | $423.94 | $450.93 | $4,913.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.80 / $2,428.80 / $2,428.80
| Facility | | $2,428.80 | $2,428.80 | $2,428.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $813.00 / $976.00 / $1,477.00
| Professional | | $813.00 | $976.00 | $1,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $571.66 / $851.46 / $1,172.28
| Professional | | $571.66 | $851.46 | $1,172.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $593.40 / $852.25 / $1,475.51
| Professional | | $593.40 | $852.25 | $1,475.51 |