- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $598.39 / $1,160.88 / $2,303.78
| Facility | | $598.39 | $1,160.88 | $2,303.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $457.10 / $559.85 / $603.59
| Professional | | $457.10 | $559.85 | $603.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $429.62 / $571.69 / $828.02
| Professional | | $429.62 | $571.69 | $828.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $661.61 / $806.19 / $1,270.09
| Facility | | $661.61 | $806.19 | $1,270.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $369.11 / $578.24 / $943.72
| Professional | | $369.11 | $578.24 | $943.72 |