- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.52 / $585.85 / $603.34
| Professional | | $448.52 | $585.85 | $603.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $612.08 / $612.08 / $773.30
| Professional | | $612.08 | $612.08 | $773.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,355.54 / $2,355.54 / $2,355.54
| Facility | | $2,355.54 | $2,355.54 | $2,355.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $73.42 / $2,355.54 / $2,355.54
| Professional | | $73.42 | $2,355.54 | $2,355.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $99.86 / $99.86 / $99.86
| Professional | | $99.86 | $99.86 | $99.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.58 / $437.19 / $728.65
| Professional | | $350.58 | $437.19 | $728.65 |