- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $572.38 / $655.98 / $844.84
| Professional | | $572.38 | $655.98 | $844.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $20,497.21 / $20,497.21 / $24,862.63
| Facility | | $20,497.21 | $20,497.21 | $24,862.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $960.85 / $960.85 / $960.85
| Professional | | $960.85 | $960.85 | $960.85 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.43 / $843.12 / $1,793.68
| Professional | | $727.43 | $843.12 | $1,793.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $727.43 / $843.12 / $1,793.68
| Professional | | $727.43 | $843.12 | $1,793.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $518.74 / $726.45 / $2,201.54
| Professional | | $518.74 | $726.45 | $2,201.54 |