- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.69 / $466.29 / $706.43
| Professional | | $444.69 | $466.29 | $706.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,324.00 / $1,589.00 / $2,459.00
| Professional | | $1,324.00 | $1,589.00 | $2,459.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $514.27 / $849.20 / $1,102.51
| Professional | | $514.27 | $849.20 | $1,102.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $5,484.78 / $14,634.00
| Facility | | $4,200.00 | $5,484.78 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $559.86 / $907.83 / $1,808.42
| Professional | | $559.86 | $907.83 | $1,808.42 |