- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $537.41 / $643.88 / $1,077.79
| Professional | | $537.41 | $643.88 | $1,077.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $32.00 / $395.00 / $427.00
| Professional | | $32.00 | $395.00 | $427.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $103.60 / $363.10 / $770.30
| Professional | | $103.60 | $363.10 | $770.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.04 / $490.77 / $490.77
| Facility | | $479.04 | $490.77 | $490.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,061.64 / $1,195.82 / $1,195.82
| Professional | | $1,061.64 | $1,195.82 | $1,195.82 |