- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $301.61 / $326.25 / $429.74
| Professional | | $301.61 | $326.25 | $429.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $843.00 / $1,012.00 / $1,565.00
| Professional | | $843.00 | $1,012.00 | $1,565.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $347.93 / $541.89 / $858.61
| Professional | | $347.93 | $541.89 | $858.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $379.52 / $640.91 / $1,458.62
| Professional | | $379.52 | $640.91 | $1,458.62 |