- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.25 / $425.33 / $514.84
| Professional | | $338.25 | $425.33 | $514.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.80 / $2,428.80 / $2,428.80
| Facility | | $2,428.80 | $2,428.80 | $2,428.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $654.00 / $943.00 / $1,427.00
| Professional | | $654.00 | $943.00 | $1,427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $436.13 / $722.01 / $1,388.39
| Professional | | $436.13 | $722.01 | $1,388.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $494.01 / $935.43 / $1,472.90
| Professional | | $494.01 | $935.43 | $1,472.90 |