- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.46 / $441.61 / $628.82
| Professional | | $420.46 | $441.61 | $628.82 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,191.00 / $1,429.00 / $2,212.00
| Professional | | $1,191.00 | $1,429.00 | $2,212.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.49 / $771.61 / $1,076.39
| Professional | | $451.49 | $771.61 | $1,076.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $1,275.00 / $3,239.00
| Facility | | $1,275.00 | $1,275.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.91 / $820.77 / $1,824.24
| Professional | | $503.91 | $820.77 | $1,824.24 |