- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $316.33 / $445.73 / $563.45
| Professional | | $316.33 | $445.73 | $563.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $910.00 / $1,408.00 / $2,186.00
| Professional | | $910.00 | $1,408.00 | $2,186.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.72 / $615.92 / $1,057.29
| Professional | | $378.72 | $615.92 | $1,057.29 |
- 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
- $541.91 / $1,046.89 / $1,813.69
| Professional | | $541.91 | $1,046.89 | $1,813.69 |