- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.33 / $1,047.13 / $1,412.54
| Professional | | $93.33 | $1,047.13 | $1,412.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $114.82 / $114.82 / $114.82
| Professional | | $114.82 | $114.82 | $114.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $120.23 / $120.23 / $2,630.27
| Facility | | $120.23 | $120.23 | $2,630.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $102.33 / $102.33 / $1,584.89
| Professional | | $102.33 | $102.33 | $1,584.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $51.29 / $91.20 / $1,995.26
| Facility | | $51.29 | $91.20 | $1,995.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.71 / $77.62 / $120.23
| Professional | | $45.71 | $77.62 | $120.23 |