- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $320.45 / $320.45 / $328.42
| Professional | | $320.45 | $320.45 | $328.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $949.00 / $1,534.00 / $1,567.00
| Professional | | $949.00 | $1,534.00 | $1,567.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.62 / $441.51 / $637.74
| Professional | | $330.62 | $441.51 | $637.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $293.00 / $293.00 / $3,239.00
| Facility | | $293.00 | $293.00 | $3,239.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $330.65 / $643.60 / $1,032.20
| Professional | | $330.65 | $643.60 | $1,032.20 |