- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $306.38 / $306.38 / $411.58
| Professional | | $306.38 | $306.38 | $411.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $796.00 / $1,055.00 / $1,632.00
| Professional | | $796.00 | $1,055.00 | $1,632.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $397.75 / $551.90 / $945.58
| Professional | | $397.75 | $551.90 | $945.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $6,486.14 / $10,877.00
| Facility | | $2,607.00 | $6,486.14 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $560.99 / $973.58 / $1,586.63
| Professional | | $560.99 | $973.58 | $1,586.63 |