- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $450.70 / $513.19 / $774.06
| Professional | | $450.70 | $513.19 | $774.06 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,456.00 / $1,747.00 / $2,704.00
| Professional | | $1,456.00 | $1,747.00 | $2,704.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $567.01 / $931.44 / $1,269.58
| Professional | | $567.01 | $931.44 | $1,269.58 |
- 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
- $558.55 / $1,013.44 / $1,891.56
| Professional | | $558.55 | $1,013.44 | $1,891.56 |