- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.61 / $422.95 / $600.83
| Professional | | $376.61 | $422.95 | $600.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,092.00 / $1,310.00 / $2,027.00
| Professional | | $1,092.00 | $1,310.00 | $2,027.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.94 / $708.61 / $984.10
| Professional | | $419.94 | $708.61 | $984.10 |
- 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
- $418.76 / $778.06 / $1,613.04
| Professional | | $418.76 | $778.06 | $1,613.04 |