- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $341.94 / $341.94 / $540.16
| Professional | | $341.94 | $341.94 | $540.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $443.00 / $699.00 / $932.00
| Professional | | $443.00 | $699.00 | $932.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.60 / $592.77 / $871.84
| Professional | | $372.60 | $592.77 | $871.84 |
- 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
- $493.45 / $872.40 / $1,527.51
| Professional | | $493.45 | $872.40 | $1,527.51 |