- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,114.88 / $1,342.34 / $2,183.31
| Professional | | $1,114.88 | $1,342.34 | $2,183.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $483.00 / $483.00 / $483.00
| Professional | | $483.00 | $483.00 | $483.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.40 / $436.70 / $669.40
| Professional | | $367.40 | $436.70 | $669.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.08 / $7,738.55 / $12,000.00
| Facility | | $900.08 | $7,738.55 | $12,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,018.00 / $2,056.65 / $2,056.65
| Professional | | $2,018.00 | $2,056.65 | $2,056.65 |