- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.41 / $207.45 / $8,963.12
| Professional | | $173.41 | $207.45 | $8,963.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.00 / $631.00 / $977.00
| Professional | | $526.00 | $631.00 | $977.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $205.98 / $341.73 / $424.46
| Professional | | $205.98 | $341.73 | $424.46 |
- 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
- $206.84 / $349.22 / $765.61
| Professional | | $206.84 | $349.22 | $765.61 |