- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $490.50 / $713.45 / $7,754.68
| Facility | | $490.50 | $713.45 | $7,754.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $490.50 / $602.64 / $616.46
| Professional | | $490.50 | $602.64 | $616.46 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $464.28 / $658.45 / $936.03
| Professional | | $464.28 | $658.45 | $936.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,129.03 / $6,140.65 / $8,034.19
| Facility | | $1,129.03 | $6,140.65 | $8,034.19 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $500.20 / $722.14 / $1,962.40
| Professional | | $500.20 | $722.14 | $1,962.40 |