- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.45 / $377.10 / $483.70
| Professional | | $269.45 | $377.10 | $483.70 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $820.00 / $1,224.00 / $1,894.00
| Professional | | $820.00 | $1,224.00 | $1,894.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $328.23 / $542.29 / $926.08
| Professional | | $328.23 | $542.29 | $926.08 |
- 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
- $469.69 / $823.41 / $1,519.31
| Professional | | $469.69 | $823.41 | $1,519.31 |