- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $660.69 / $1,819.70 / $2,511.89
| Facility | | $660.69 | $1,819.70 | $2,511.89 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $524.81 / $616.60 / $831.76
| Professional | | $524.81 | $616.60 | $831.76 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $602.56 / $954.99 / $1,202.26
| Professional | | $602.56 | $954.99 | $1,202.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $1,071.52 / $2,570.40
| Facility | | $371.54 | $1,071.52 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $512.86 / $707.95 / $1,174.90
| Professional | | $512.86 | $707.95 | $1,174.90 |