- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $348.05 / $441.28 / $645.38
| Professional | | $348.05 | $441.28 | $645.38 |
- 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
- $670.00 / $921.00 / $1,393.00
| Professional | | $670.00 | $921.00 | $1,393.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $468.40 / $768.06 / $1,356.93
| Professional | | $468.40 | $768.06 | $1,356.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $543.02 / $978.63 / $1,651.01
| Professional | | $543.02 | $978.63 | $1,651.01 |