- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $35.00 / $811.76 / $966.14
| Facility | | $35.00 | $811.76 | $966.14 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $34.79 / $976.84 / $1,302.45
| Professional | | $34.79 | $976.84 | $1,302.45 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,321.68 / $1,321.68 / $1,554.91
| Professional | | $1,321.68 | $1,321.68 | $1,554.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $482.54 / $1,077.57 / $1,077.57
| Professional | | $482.54 | $1,077.57 | $1,077.57 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,519.93 / $1,519.93 / $1,788.15
| Professional | | $1,519.93 | $1,519.93 | $1,788.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $907.65 / $1,143.42 / $1,565.00
| Professional | | $907.65 | $1,143.42 | $1,565.00 |