- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.34 / $361.48 / $447.06
| Professional | | $250.34 | $361.48 | $447.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $693.00 / $1,073.00 / $1,757.00
| Professional | | $693.00 | $1,073.00 | $1,757.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $313.26 / $509.98 / $870.88
| Professional | | $313.26 | $509.98 | $870.88 |
- 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
- $435.73 / $732.03 / $1,492.94
| Professional | | $435.73 | $732.03 | $1,492.94 |