- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $532.04 / $942.30 / $1,361.28
| Professional | | $532.04 | $942.30 | $1,361.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.05 / $1,171.05 / $1,328.39
| Professional | | $1,171.05 | $1,171.05 | $1,328.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.87 / $109.87 / $109.87
| Facility | | $109.87 | $109.87 | $109.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.39 / $93.39 / $113.17
| Professional | | $93.39 | $93.39 | $113.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $82.58 / $97.05 / $620.65
| Professional | | $82.58 | $97.05 | $620.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.92 / $949.92 / $1,558.39
| Professional | | $949.92 | $949.92 | $1,558.39 |