- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.75 / $734.77 / $2,678.30
| Facility | | $539.75 | $734.77 | $2,678.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $381.90 / $565.21 / $661.96
| Professional | | $381.90 | $565.21 | $661.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $551.36 / $994.42 / $1,566.91
| Facility | | $551.36 | $994.42 | $1,566.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.67 / $976.64 / $3,597.23
| Facility | | $532.67 | $976.64 | $3,597.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $269.88 / $585.22 / $731.53
| Professional | | $269.88 | $585.22 | $731.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.86 / $254.60 / $687.42
| Professional | | $213.86 | $254.60 | $687.42 |