- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $217.16 / $219.08 / $323.79
| Professional | | $217.16 | $219.08 | $323.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.00 / $751.00 / $1,163.00
| Professional | | $626.00 | $751.00 | $1,163.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.47 / $396.04 / $578.97
| Professional | | $249.47 | $396.04 | $578.97 |
- 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
- $240.34 / $450.64 / $847.59
| Professional | | $240.34 | $450.64 | $847.59 |