- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.83 / $355.66 / $431.94
| Professional | | $279.83 | $355.66 | $431.94 |
- 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
- $541.00 / $803.00 / $1,214.00
| Professional | | $541.00 | $803.00 | $1,214.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.87 / $616.85 / $1,184.77
| Professional | | $380.87 | $616.85 | $1,184.77 |
- 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
- $469.30 / $846.29 / $1,393.61
| Professional | | $469.30 | $846.29 | $1,393.61 |