- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.23 / $343.17 / $517.39
| Professional | | $329.23 | $343.17 | $517.39 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $986.00 / $1,183.00 / $1,830.00
| Professional | | $986.00 | $1,183.00 | $1,830.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $382.84 / $630.84 / $855.06
| Professional | | $382.84 | $630.84 | $855.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $5,484.78 / $10,877.00
| Facility | | $2,607.00 | $5,484.78 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $378.15 / $750.15 / $1,415.03
| Professional | | $378.15 | $750.15 | $1,415.03 |