- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.45 / $485.24 / $1,126.84
| Professional | | $300.45 | $485.24 | $1,126.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,680.35 / $4,680.35 / $5,994.13
| Facility | | $4,680.35 | $4,680.35 | $5,994.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,040.64 / $1,040.64 / $1,040.64
| Professional | | $1,040.64 | $1,040.64 | $1,040.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.58 / $1,087.83 / $3,069.19
| Professional | | $384.58 | $1,087.83 | $3,069.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.58 / $1,087.83 / $3,069.19
| Professional | | $384.58 | $1,087.83 | $3,069.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,073.90 / $1,165.28 / $3,767.09
| Professional | | $1,073.90 | $1,165.28 | $3,767.09 |