- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $292.32 / $401.13 / $645.11
| Professional | | $292.32 | $401.13 | $645.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $890.00 / $1,243.00 / $1,924.00
| Professional | | $890.00 | $1,243.00 | $1,924.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.00 / $601.21 / $1,033.07
| Professional | | $360.00 | $601.21 | $1,033.07 |
- 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
- $463.75 / $821.51 / $1,675.09
| Professional | | $463.75 | $821.51 | $1,675.09 |