- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.00 / $1,382.40 / $1,382.40
| Facility | | $784.00 | $1,382.40 | $1,382.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $30.00 / $50.00 / $1,382.40
| Professional | | $30.00 | $50.00 | $1,382.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $73.04 / $284.06 / $681.74
| Facility | | $73.04 | $284.06 | $681.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $162.32 / $535.65 / $1,264.80
| Professional | | $162.32 | $535.65 | $1,264.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $630.00 / $900.00 / $1,290.00
| Professional | | $630.00 | $900.00 | $1,290.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $45.00 / $60.00 / $78.00
| Professional | | $45.00 | $60.00 | $78.00 |