- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $254.02 / $348.84 / $428.09
| Professional | | $254.02 | $348.84 | $428.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $719.00 / $1,062.00 / $1,643.00
| Professional | | $719.00 | $1,062.00 | $1,643.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $285.95 / $487.72 / $831.20
| Professional | | $285.95 | $487.72 | $831.20 |
- 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
- $407.44 / $725.71 / $1,412.39
| Professional | | $407.44 | $725.71 | $1,412.39 |