- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.79 / $385.49 / $1,382.69
| Professional | | $201.79 | $385.49 | $1,382.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.00 / $796.00 / $3,286.00
| Professional | | $515.00 | $796.00 | $3,286.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $283.32 / $767.13 / $2,070.63
| Professional | | $283.32 | $767.13 | $2,070.63 |
- 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
- $1,057.97 / $1,856.25 / $4,223.99
| Professional | | $1,057.97 | $1,856.25 | $4,223.99 |