- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $230.48 / $7,838.38 / $7,838.38
| Facility | | $230.48 | $7,838.38 | $7,838.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.10 / $230.48 / $239.77
| Professional | | $219.10 | $230.48 | $239.77 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $60.00 / $85.00 / $360.93
| Professional | | $60.00 | $85.00 | $360.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,602.00 / $9,127.00 / $10,150.00
| Facility | | $6,602.00 | $9,127.00 | $10,150.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $295.24 / $369.05 / $530.08
| Professional | | $295.24 | $369.05 | $530.08 |