- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $330.61 / $516.00 / $1,241.30
| Facility | | $330.61 | $516.00 | $1,241.30 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $221.43 / $278.43 / $477.98
| Professional | | $221.43 | $278.43 | $477.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.33 / $454.94 / $977.40
| Facility | | $265.33 | $454.94 | $977.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.24 / $259.50 / $442.58
| Professional | | $219.24 | $259.50 | $442.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $593.50 / $593.50 / $593.50
| Facility | | $593.50 | $593.50 | $593.50 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $665.33 / $665.33 / $665.33
| Professional | | $665.33 | $665.33 | $665.33 |