- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.24 / $525.47 / $792.91
| Professional | | $471.24 | $525.47 | $792.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,494.00 / $1,793.00 / $2,774.00
| Professional | | $1,494.00 | $1,793.00 | $2,774.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.99 / $956.04 / $1,249.77
| Professional | | $580.99 | $956.04 | $1,249.77 |
- 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
- $573.21 / $1,031.32 / $2,019.62
| Professional | | $573.21 | $1,031.32 | $2,019.62 |