- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $694.24 / $879.12 / $4,126.71
| Professional | | $694.24 | $879.12 | $4,126.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $470.98 / $520.05
| Facility | | $55.00 | $470.98 | $520.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,869.46 / $3,558.35 / $3,853.58
| Professional | | $1,869.46 | $3,558.35 | $3,853.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $221.52 / $803.69 / $1,337.19
| Facility | | $221.52 | $803.69 | $1,337.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $5.00 / $444.90 / $1,994.20
| Professional | | $5.00 | $444.90 | $1,994.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $235.88 / $824.32 / $1,337.24
| Facility | | $235.88 | $824.32 | $1,337.24 |