- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.58 / $385.61 / $537.08
| Professional | | $282.58 | $385.61 | $537.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $746.00 / $1,026.00 / $1,587.00
| Professional | | $746.00 | $1,026.00 | $1,587.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.47 / $531.82 / $899.11
| Professional | | $337.47 | $531.82 | $899.11 |
- 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
- $393.46 / $682.01 / $1,296.08
| Professional | | $393.46 | $682.01 | $1,296.08 |