- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,198.79 / $1,605.92 / $7,328.15
| Professional | | $1,198.79 | $1,605.92 | $7,328.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $154.74 / $206.32 / $245.84
| Professional | | $154.74 | $206.32 | $245.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,460.50 / $1,460.50 / $1,460.50
| Facility | | $1,460.50 | $1,460.50 | $1,460.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.50 / $1,460.50 / $1,825.63
| Professional | | $1,460.50 | $1,460.50 | $1,825.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.35 / $1,234.84 / $4,145.16
| Professional | | $378.35 | $1,234.84 | $4,145.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $707.15 / $1,266.64 / $1,990.44
| Facility | | $707.15 | $1,266.64 | $1,990.44 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,460.50 / $1,460.50 / $1,825.63
| Professional | | $1,460.50 | $1,460.50 | $1,825.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $928.36 / $1,095.38 / $1,650.02
| Professional | | $928.36 | $1,095.38 | $1,650.02 |