- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.64 / $326.64 / $500.72
| Professional | | $326.64 | $326.64 | $500.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $966.00 / $1,561.00 / $2,323.00
| Professional | | $966.00 | $1,561.00 | $2,323.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.93 / $619.39 / $905.27
| Professional | | $433.93 | $619.39 | $905.27 |
- 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
- $426.33 / $921.30 / $1,477.86
| Professional | | $426.33 | $921.30 | $1,477.86 |