- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.43 / $732.36 / $5,405.38
| Professional | | $413.43 | $732.36 | $5,405.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.03 / $1,407.03 / $1,407.03
| Facility | | $1,407.03 | $1,407.03 | $1,407.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.01 / $1,207.51 / $1,888.52
| Professional | | $966.01 | $1,207.51 | $1,888.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,407.03 / $1,407.03 / $1,407.03
| Facility | | $1,407.03 | $1,407.03 | $1,407.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $264.72 / $966.01 / $1,888.52
| Professional | | $264.72 | $966.01 | $1,888.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $354.37 / $504.39 / $1,942.24
| Professional | | $354.37 | $504.39 | $1,942.24 |