- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $172.78 / $291.44 / $567.40
| Professional | | $172.78 | $291.44 | $567.40 |
- 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
- $338.00 / $512.00 / $859.00
| Professional | | $338.00 | $512.00 | $859.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $304.93 / $612.75 / $1,257.16
| Professional | | $304.93 | $612.75 | $1,257.16 |
- 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
- $789.38 / $1,133.73 / $1,744.20
| Professional | | $789.38 | $1,133.73 | $1,744.20 |