- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.40 / $719.19 / $1,052.08
| Professional | | $594.40 | $719.19 | $1,052.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $456.71 / $478.36 / $500.00
| Professional | | $456.71 | $478.36 | $500.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,056.61 / $1,056.61 / $1,056.61
| Professional | | $1,056.61 | $1,056.61 | $1,056.61 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $590.97 / $590.97 / $590.97
| Professional | | $590.97 | $590.97 | $590.97 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $594.40 / $719.19 / $1,052.08
| Professional | | $594.40 | $719.19 | $1,052.08 |