- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,664.74 / $1,664.74 / $2,946.15
| Facility | | $1,664.74 | $1,664.74 | $2,946.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $318.22 / $318.22 / $1,946.66
| Professional | | $318.22 | $318.22 | $1,946.66 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.64 / $70.34 / $111.51
| Professional | | $60.64 | $70.34 | $111.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $64.00 / $64.00 / $64.00
| Facility | | $64.00 | $64.00 | $64.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.84 / $673.84 / $673.84
| Professional | | $673.84 | $673.84 | $673.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $673.84 / $673.84 / $673.84
| Professional | | $673.84 | $673.84 | $673.84 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $40.00 / $50.00 / $60.00
| Professional | | $40.00 | $50.00 | $60.00 |