- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $375.51 / $375.51 / $434.34
| Professional | | $375.51 | $375.51 | $434.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $574.00 / $658.00 / $785.00
| Professional | | $574.00 | $658.00 | $785.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $475.84 / $621.85 / $897.33
| Professional | | $475.84 | $621.85 | $897.33 |
- 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
- $562.65 / $946.20 / $1,515.35
| Professional | | $562.65 | $946.20 | $1,515.35 |