- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $912.01 / $4,466.84
| Professional | | $724.44 | $912.01 | $4,466.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $6,165.95
| Professional | | $151.36 | $151.36 | $6,165.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,202.26 / $4,265.80 / $8,912.51
| Facility | | $1,202.26 | $4,265.80 | $8,912.51 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $831.76 / $3,162.28 / $10,471.29
| Professional | | $831.76 | $3,162.28 | $10,471.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $575.44 / $3,162.28
| Professional | | $575.44 | $575.44 | $3,162.28 |