- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.31 / $415.47 / $548.72
| Professional | | $310.31 | $415.47 | $548.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $965.00 / $1,386.00 / $2,144.00
| Professional | | $965.00 | $1,386.00 | $2,144.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.46 / $626.21 / $1,078.17
| Professional | | $365.46 | $626.21 | $1,078.17 |
- 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
- $403.52 / $872.40 / $1,574.22
| Professional | | $403.52 | $872.40 | $1,574.22 |