- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $376.07 / $427.03 / $672.20
| Professional | | $376.07 | $427.03 | $672.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,187.00 / $1,424.00 / $2,204.00
| Professional | | $1,187.00 | $1,424.00 | $2,204.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.63 / $728.48 / $997.58
| Professional | | $439.63 | $728.48 | $997.58 |
- 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
- $400.32 / $766.19 / $1,651.32
| Professional | | $400.32 | $766.19 | $1,651.32 |