- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.39 / $310.35 / $353.73
| Professional | | $249.39 | $310.35 | $353.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $677.00 / $864.00 / $1,337.00
| Professional | | $677.00 | $864.00 | $1,337.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $276.24 / $457.50 / $746.73
| Professional | | $276.24 | $457.50 | $746.73 |
- 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
- $335.56 / $563.77 / $1,283.06
| Professional | | $335.56 | $563.77 | $1,283.06 |