- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $430.49 / $441.53 / $2,858.58
| Professional | | $430.49 | $441.53 | $2,858.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.56 / $2,292.56 / $7,473.86
| Facility | | $2,292.56 | $2,292.56 | $7,473.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.51 / $374.53 / $1,238.82
| Professional | | $359.51 | $374.53 | $1,238.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,292.56 / $2,292.56 / $7,473.86
| Facility | | $2,292.56 | $2,292.56 | $7,473.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $359.51 / $374.53 / $1,238.82
| Professional | | $359.51 | $374.53 | $1,238.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.02 / $2,168.40 / $6,950.26
| Professional | | $382.02 | $2,168.40 | $6,950.26 |