- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.40 / $1,789.77 / $9,733.78
| Facility | | $696.40 | $1,789.77 | $9,733.78 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.39 / $696.41 / $808.81
| Professional | | $681.39 | $696.41 | $808.81 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $659.65 / $777.71 / $1,104.36
| Professional | | $659.65 | $777.71 | $1,104.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,191.99 / $5,817.03 / $9,625.48
| Facility | | $5,191.99 | $5,817.03 | $9,625.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $580.79 / $809.61 / $1,849.65
| Professional | | $580.79 | $809.61 | $1,849.65 |