- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $384.16 / $384.16 / $545.54
| Professional | | $384.16 | $384.16 | $545.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $974.00 / $1,508.00 / $2,148.00
| Professional | | $974.00 | $1,508.00 | $2,148.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $454.73 / $633.59 / $920.35
| Professional | | $454.73 | $633.59 | $920.35 |
- 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
- $488.07 / $882.60 / $1,592.64
| Professional | | $488.07 | $882.60 | $1,592.64 |