- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,047.13 / $1,047.13 / $1,288.25
| Professional | | $1,047.13 | $1,047.13 | $1,288.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $151.36 / $1,202.26
| Professional | | $151.36 | $151.36 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.54 / $891.25 / $1,348.96
| Facility | | $549.54 | $891.25 | $1,348.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $724.44 / $6,309.57 / $6,309.57
| Professional | | $724.44 | $6,309.57 | $6,309.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $891.25 / $891.25 / $891.25
| Professional | | $891.25 | $891.25 | $891.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |