- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.41 / $762.93 / $9,234.20
| Facility | | $506.41 | $762.93 | $9,234.20 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $195.45 / $281.14 / $296.86
| Professional | | $195.45 | $281.14 | $296.86 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $196.77 / $300.70 / $486.76
| Professional | | $196.77 | $300.70 | $486.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,972.92 / $7,972.92 / $7,972.92
| Facility | | $7,972.92 | $7,972.92 | $7,972.92 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $282.18 / $362.39 / $953.92
| Professional | | $282.18 | $362.39 | $953.92 |