- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.08 / $2,410.82 / $3,160.75
| Facility | | $460.08 | $2,410.82 | $3,160.75 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $336.11 / $403.85 / $460.08
| Professional | | $336.11 | $403.85 | $460.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $436.95 / $449.40 / $1,408.53
| Facility | | $436.95 | $449.40 | $1,408.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $587.29 / $587.29 / $734.11
| Professional | | $587.29 | $587.29 | $734.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $391.30 / $400.04 / $434.78
| Professional | | $391.30 | $400.04 | $434.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $214.70 / $214.70 / $306.72
| Professional | | $214.70 | $214.70 | $306.72 |