- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $382.35 / $1,505.79 / $3,031.03
| Facility | | $382.35 | $1,505.79 | $3,031.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $367.13 / $382.35 / $925.28
| Professional | | $367.13 | $382.35 | $925.28 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $434.20 / $434.20 / $1,396.67
| Professional | | $434.20 | $434.20 | $1,396.67 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.53 / $429.13 / $1,871.12
| Professional | | $342.53 | $429.13 | $1,871.12 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $438.46 / $948.52 / $948.52
| Professional | | $438.46 | $948.52 | $948.52 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $315.95 / $585.36 / $1,344.77
| Professional | | $315.95 | $585.36 | $1,344.77 |