- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $275.42 / $851.14 / $1,621.81
| Professional | | $275.42 | $851.14 | $1,621.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $2,238.72 / $2,884.03
| Facility | | $2,238.72 | $2,238.72 | $2,884.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,737.80 / $1,737.80 / $3,890.45
| Professional | | $1,737.80 | $1,737.80 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $724.44 / $3,019.95
| Professional | | $380.19 | $724.44 | $3,019.95 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,778.28 / $1,778.28 / $3,890.45
| Professional | | $1,778.28 | $1,778.28 | $3,890.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.12 / $1,174.90 / $2,754.23
| Professional | | $295.12 | $1,174.90 | $2,754.23 |