- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $201.96 / $290.62 / $1,036.83
| Professional | | $201.96 | $290.62 | $1,036.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $526.00 / $814.00 / $3,139.00
| Professional | | $526.00 | $814.00 | $3,139.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.01 / $728.53 / $1,954.40
| Professional | | $282.01 | $728.53 | $1,954.40 |
- 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
- $928.64 / $1,564.26 / $3,830.64
| Professional | | $928.64 | $1,564.26 | $3,830.64 |