- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.98 / $446.05 / $599.76
| Professional | | $331.98 | $446.05 | $599.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $845.00 / $1,159.00 / $1,794.00
| Professional | | $845.00 | $1,159.00 | $1,794.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $374.08 / $641.69 / $1,081.64
| Professional | | $374.08 | $641.69 | $1,081.64 |
- 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
- $478.46 / $836.01 / $1,817.65
| Professional | | $478.46 | $836.01 | $1,817.65 |