- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.29 / $381.72 / $571.47
| Professional | | $377.29 | $381.72 | $571.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,082.00 / $1,298.00 / $2,009.00
| Professional | | $1,082.00 | $1,298.00 | $2,009.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.54 / $701.26 / $956.07
| Professional | | $409.54 | $701.26 | $956.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $424.78 / $743.44 / $1,597.18
| Professional | | $424.78 | $743.44 | $1,597.18 |