- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $989.14 / $1,042.52 / $9,113.37
| Facility | | $989.14 | $1,042.52 | $9,113.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.60 / $414.43 / $463.59
| Professional | | $362.60 | $414.43 | $463.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $640.00 / $640.00 / $640.00
| Facility | | $640.00 | $640.00 | $640.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $302.60 / $334.22 / $548.05
| Professional | | $302.60 | $334.22 | $548.05 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.58 / $360.58 / $360.58
| Professional | | $360.58 | $360.58 | $360.58 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $305.63 / $360.78 / $867.93
| Professional | | $305.63 | $360.78 | $867.93 |