- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $585.63 / $585.63 / $743.12
| Professional | | $585.63 | $585.63 | $743.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $660.00 / $825.00 / $1,040.09
| Professional | | $660.00 | $825.00 | $1,040.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.02 / $766.64 / $766.64
| Facility | | $309.02 | $766.64 | $766.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $651.64 / $651.64 / $1,230.00
| Professional | | $651.64 | $651.64 | $1,230.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.60 / $585.63 / $743.12
| Facility | | $341.60 | $585.63 | $743.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.00 / $602.00 / $602.00
| Professional | | $602.00 | $602.00 | $602.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $317.51 / $440.89 / $612.62
| Professional | | $317.51 | $440.89 | $612.62 |