- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $281.84 / $1,288.25 / $2,454.71
| Facility | | $281.84 | $1,288.25 | $2,454.71 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $245.47 / $380.19
| Professional | | $208.93 | $245.47 | $380.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $512.86 / $537.03 / $562.34
| Facility | | $512.86 | $537.03 | $562.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.87 / $316.23 / $416.87
| Professional | | $223.87 | $316.23 | $416.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $371.54 / $758.58 / $2,570.40
| Facility | | $371.54 | $758.58 | $2,570.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $208.93 / $275.42 / $436.52
| Professional | | $208.93 | $275.42 | $436.52 |