- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.79 / $352.79 / $538.62
| Professional | | $352.79 | $352.79 | $538.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,030.00 / $1,666.00 / $2,506.00
| Professional | | $1,030.00 | $1,666.00 | $2,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.45 / $662.46 / $968.21
| Professional | | $464.45 | $662.46 | $968.21 |
- 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
- $527.70 / $1,023.90 / $1,591.56
| Professional | | $527.70 | $1,023.90 | $1,591.56 |