- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $345.69 / $422.76 / $774.52
| Professional | | $345.69 | $422.76 | $774.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,097.00 / $1,316.00 / $2,036.00
| Professional | | $1,097.00 | $1,316.00 | $2,036.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $425.83 / $701.13 / $923.49
| Professional | | $425.83 | $701.13 | $923.49 |
- 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
- $432.02 / $835.13 / $1,574.77
| Professional | | $432.02 | $835.13 | $1,574.77 |