- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $489.78 / $851.14
| Professional | | $331.13 | $489.78 | $851.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $602.56 / $1,000.00
| Professional | | $338.84 | $602.56 | $1,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.84 / $588.84 / $616.60
| Facility | | $588.84 | $588.84 | $616.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $363.08 / $588.84 / $1,122.02
| Professional | | $363.08 | $588.84 | $1,122.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.05 / $724.44 / $1,380.38
| Professional | | $389.05 | $724.44 | $1,380.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $338.84 / $562.34 / $1,258.93
| Professional | | $338.84 | $562.34 | $1,258.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $371.54 / $602.56 / $1,071.52
| Professional | | $371.54 | $602.56 | $1,071.52 |