- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.37 / $368.42 / $481.84
| Professional | | $318.37 | $368.42 | $481.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $947.00 / $1,136.00 / $1,758.00
| Professional | | $947.00 | $1,136.00 | $1,758.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.25 / $608.21 / $1,492.50
| Professional | | $365.25 | $608.21 | $1,492.50 |
- 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
- $397.78 / $635.07 / $1,409.44
| Professional | | $397.78 | $635.07 | $1,409.44 |