- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.33 / $345.87 / $509.40
| Professional | | $344.33 | $345.87 | $509.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.00 / $1,182.00 / $1,829.00
| Professional | | $985.00 | $1,182.00 | $1,829.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $392.33 / $623.09 / $909.60
| Professional | | $392.33 | $623.09 | $909.60 |
- 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
- $419.32 / $710.48 / $1,344.21
| Professional | | $419.32 | $710.48 | $1,344.21 |