- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $318.75 / $738.00 / $900.00
| Facility | | $318.75 | $738.00 | $900.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $280.16 / $318.75 / $425.00
| Professional | | $280.16 | $318.75 | $425.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.00 / $706.00 / $1,000.00
| Facility | | $510.00 | $706.00 | $1,000.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $311.38 / $591.61 / $643.54
| Professional | | $311.38 | $591.61 | $643.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,509.07 / $1,509.07 / $1,509.07
| Facility | | $1,509.07 | $1,509.07 | $1,509.07 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $344.35 / $344.35 / $344.35
| Professional | | $344.35 | $344.35 | $344.35 |