- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.57 / $284.57 / $399.81
| Professional | | $284.57 | $284.57 | $399.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $528.00 / $745.00 / $1,117.00
| Professional | | $528.00 | $745.00 | $1,117.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $389.02 / $568.91 / $840.04
| Professional | | $389.02 | $568.91 | $840.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.00 / $788.00 / $3,328.00
| Facility | | $788.00 | $788.00 | $3,328.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $610.40 / $801.77 / $1,669.82
| Professional | | $610.40 | $801.77 | $1,669.82 |