- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,270.69 / $2,508.03 / $3,259.54
| Professional | | $2,270.69 | $2,508.03 | $3,259.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $441.33 / $441.33 / $441.33
| Facility | | $441.33 | $441.33 | $441.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.76 / $326.76 / $326.76
| Professional | | $326.76 | $326.76 | $326.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,569.13 / $2,569.13 / $4,080.53
| Facility | | $2,569.13 | $2,569.13 | $4,080.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.60 / $2,183.76 / $2,569.13
| Professional | | $295.60 | $2,183.76 | $2,569.13 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $118.24 / $196.41 / $521.66
| Professional | | $118.24 | $196.41 | $521.66 |