- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $547.71 / $684.63 / $1,146.55
| Professional | | $547.71 | $684.63 | $1,146.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,561.75 / $9,561.75 / $9,561.75
| Facility | | $9,561.75 | $9,561.75 | $9,561.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $452.00 / $3,301.00 / $3,301.00
| Professional | | $452.00 | $3,301.00 | $3,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $452.00 / $452.00
| Facility | | $452.00 | $452.00 | $452.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $413.00 / $512.11 / $524.29
| Professional | | $413.00 | $512.11 | $524.29 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $7.00 / $442.40 / $692.80
| Professional | | $7.00 | $442.40 | $692.80 |