- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.68 / $231.17 / $314.27
| Professional | | $212.68 | $231.17 | $314.27 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $592.00 / $710.00 / $1,099.00
| Professional | | $592.00 | $710.00 | $1,099.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.79 / $383.30 / $736.22
| Professional | | $241.79 | $383.30 | $736.22 |
- 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
- $265.19 / $420.84 / $920.03
| Professional | | $265.19 | $420.84 | $920.03 |