- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,075.09 / $1,189.83 / $1,425.56
| Professional | | $1,075.09 | $1,189.83 | $1,425.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $101.00 / $316.00 / $417.00
| Professional | | $101.00 | $316.00 | $417.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.80 / $411.80 / $830.00
| Professional | | $411.80 | $411.80 | $830.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $630.33 / $1,251.36 / $1,251.36
| Facility | | $630.33 | $1,251.36 | $1,251.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,245.76 / $1,522.86 / $1,522.86
| Professional | | $1,245.76 | $1,522.86 | $1,522.86 |