- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $260.74 / $260.74 / $631.38
| Professional | | $260.74 | $260.74 | $631.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $508.00 / $635.00 / $1,477.00
| Professional | | $508.00 | $635.00 | $1,477.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $358.39 / $619.19 / $1,140.02
| Professional | | $358.39 | $619.19 | $1,140.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,607.00 / $2,607.00 / $10,877.00
| Facility | | $2,607.00 | $2,607.00 | $10,877.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,027.97 / $1,645.88 / $2,592.21
| Professional | | $1,027.97 | $1,645.88 | $2,592.21 |