- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $469.75 / $492.80 / $700.19
| Professional | | $469.75 | $492.80 | $700.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,331.00 / $1,597.00 / $2,471.00
| Professional | | $1,331.00 | $1,597.00 | $2,471.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $505.54 / $861.55 / $1,194.69
| Professional | | $505.54 | $861.55 | $1,194.69 |
- 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
- $507.85 / $954.42 / $1,786.18
| Professional | | $507.85 | $954.42 | $1,786.18 |