- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.08 / $304.86 / $461.11
| Professional | | $295.08 | $304.86 | $461.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $878.00 / $1,054.00 / $1,631.00
| Professional | | $878.00 | $1,054.00 | $1,631.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.84 / $562.53 / $765.67
| Professional | | $339.84 | $562.53 | $765.67 |
- 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
- $338.69 / $603.85 / $1,257.97
| Professional | | $338.69 | $603.85 | $1,257.97 |