- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.36 / $282.05 / $2,244.80
| Facility | | $280.36 | $282.05 | $2,244.80 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $271.50 / $280.36 / $427.18
| Professional | | $271.50 | $280.36 | $427.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $948.10 / $948.10 / $1,881.00
| Facility | | $948.10 | $948.10 | $1,881.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.89 / $347.27 / $497.23
| Professional | | $252.89 | $347.27 | $497.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $414.00 / $1,320.00 / $1,320.00
| Facility | | $414.00 | $1,320.00 | $1,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.55 / $322.08 / $658.68
| Professional | | $241.55 | $322.08 | $658.68 |