- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.89 / $398.87 / $1,290.30
| Professional | | $285.89 | $398.87 | $1,290.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.00 / $517.00 / $690.00
| Professional | | $372.00 | $517.00 | $690.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $353.78 / $486.83 / $708.23
| Professional | | $353.78 | $486.83 | $708.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $5,606.00
| Facility | | $1,275.00 | $1,275.00 | $5,606.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.69 / $670.80 / $1,210.44
| Professional | | $410.69 | $670.80 | $1,210.44 |