- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $501.74 / $627.17 / $844.35
| Professional | | $501.74 | $627.17 | $844.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $536.00 / $536.00 / $16,394.00
| Facility | | $536.00 | $536.00 | $16,394.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $444.00 / $611.04 / $1,530.66
| Professional | | $444.00 | $611.04 | $1,530.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.18 / $536.00 / $536.00
| Facility | | $362.18 | $536.00 | $536.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.18 / $490.00 / $611.04
| Professional | | $362.18 | $490.00 | $611.04 |