- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.81 / $404.31 / $584.91
| Professional | | $389.81 | $404.31 | $584.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,083.00 / $1,300.00 / $2,010.00
| Professional | | $1,083.00 | $1,300.00 | $2,010.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $432.00 / $691.52 / $1,044.17
| Professional | | $432.00 | $691.52 | $1,044.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,934.00 / $10,811.40 / $26,502.00
| Facility | | $6,934.00 | $10,811.40 | $26,502.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.02 / $872.05 / $1,523.60
| Professional | | $497.02 | $872.05 | $1,523.60 |