- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $266.85 / $338.79 / $421.81
| Professional | | $266.85 | $338.79 | $421.81 |
- 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
- $511.00 / $774.00 / $1,174.00
| Professional | | $511.00 | $774.00 | $1,174.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $356.82 / $588.79 / $1,133.45
| Professional | | $356.82 | $588.79 | $1,133.45 |
- 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
- $451.45 / $830.27 / $1,305.18
| Professional | | $451.45 | $830.27 | $1,305.18 |