- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.54 / $416.90 / $506.19
| Professional | | $329.54 | $416.90 | $506.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,767.20 / $2,767.20 / $2,767.20
| Facility | | $2,767.20 | $2,767.20 | $2,767.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $634.00 / $934.00 / $1,413.00
| Professional | | $634.00 | $934.00 | $1,413.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $440.82 / $720.62 / $1,379.27
| Professional | | $440.82 | $720.62 | $1,379.27 |
- 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
- $688.94 / $989.47 / $1,541.79
| Professional | | $688.94 | $989.47 | $1,541.79 |