- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $310.00 / $775.00 / $3,345.63
| Facility | | $310.00 | $775.00 | $3,345.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $310.00 / $456.22 / $497.17
| Professional | | $310.00 | $456.22 | $497.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $571.74 / $863.91 / $1,841.73
| Facility | | $571.74 | $863.91 | $1,841.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $409.43 / $766.22 / $1,065.69
| Professional | | $409.43 | $766.22 | $1,065.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.90 / $584.90 / $8,702.00
| Facility | | $584.90 | $584.90 | $8,702.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $245.66 / $350.94 / $631.69
| Professional | | $245.66 | $350.94 | $631.69 |