- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $133.24 / $259.87 / $1,094.55
| Professional | | $133.24 | $259.87 | $1,094.55 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.00 / $665.00 / $5,506.00
| Professional | | $343.00 | $665.00 | $5,506.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.02 / $563.60 / $2,353.46
| Professional | | $289.02 | $563.60 | $2,353.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,200.00 / $4,200.00 / $14,634.00
| Facility | | $4,200.00 | $4,200.00 | $14,634.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,582.64 / $2,671.50 / $4,670.16
| Professional | | $1,582.64 | $2,671.50 | $4,670.16 |