- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $122.41 / $282.11 / $3,637.20
| Professional | | $122.41 | $282.11 | $3,637.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.00 / $560.00 / $1,269.00
| Professional | | $362.00 | $560.00 | $1,269.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.01 / $301.14 / $616.80
| Professional | | $168.01 | $301.14 | $616.80 |
- 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
- $314.23 / $528.57 / $1,020.36
| Professional | | $314.23 | $528.57 | $1,020.36 |