- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.07 / $535.87 / $8,005.65
| Facility | | $520.07 | $535.87 | $8,005.65 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $441.14 / $480.66 / $630.37
| Professional | | $441.14 | $480.66 | $630.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $919.73 / $919.73 / $919.73
| Facility | | $919.73 | $919.73 | $919.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $465.71 / $551.33 / $932.74
| Professional | | $465.71 | $551.33 | $932.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,347.31 / $2,347.31 / $2,347.31
| Facility | | $2,347.31 | $2,347.31 | $2,347.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,320.00 / $1,320.00 / $1,320.00
| Facility | | $1,320.00 | $1,320.00 | $1,320.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $433.82 / $561.51 / $1,172.95
| Professional | | $433.82 | $561.51 | $1,172.95 |