- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,401.74 / $1,448.30 / $2,237.34
| Professional | | $1,401.74 | $1,448.30 | $2,237.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $0.02 / $51.47 / $350.00
| Professional | | $0.02 | $51.47 | $350.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $198.37 / $198.37
| Professional | | $198.37 | $198.37 | $198.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.01 / $985.01 / $985.01
| Professional | | $985.01 | $985.01 | $985.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $555.00 / $555.00 / $597.00
| Facility | | $555.00 | $555.00 | $597.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $198.37 / $198.37 / $198.37
| Professional | | $198.37 | $198.37 | $198.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $985.01 / $985.01 / $985.01
| Professional | | $985.01 | $985.01 | $985.01 |