- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.12 / $357.96 / $482.80
| Professional | | $329.12 | $357.96 | $482.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $913.00 / $1,096.00 / $1,694.00
| Professional | | $913.00 | $1,096.00 | $1,694.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.68 / $590.80 / $853.68
| Professional | | $367.68 | $590.80 | $853.68 |
- 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
- $408.89 / $717.42 / $1,663.19
| Professional | | $408.89 | $717.42 | $1,663.19 |