- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.98 / $335.64 / $443.24
| Professional | | $311.98 | $335.64 | $443.24 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $535.00 / $766.00 / $1,531.00
| Professional | | $535.00 | $766.00 | $1,531.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $410.43 / $613.47 / $1,055.24
| Professional | | $410.43 | $613.47 | $1,055.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,275.00 / $5,606.00 / $5,724.10
| Facility | | $1,275.00 | $5,606.00 | $5,724.10 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $642.94 / $1,118.00 / $1,816.33
| Professional | | $642.94 | $1,118.00 | $1,816.33 |