- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $553.22 / $562.94 / $630.00
| Professional | | $553.22 | $562.94 | $630.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $803.00 / $1,297.00 / $1,404.00
| Professional | | $803.00 | $1,297.00 | $1,404.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $731.39 / $950.81 / $1,389.64
| Professional | | $731.39 | $950.81 | $1,389.64 |
- 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
- $504.00 / $703.58 / $2,314.01
| Professional | | $504.00 | $703.58 | $2,314.01 |