- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.53 / $1,955.20 / $5,508.35
| Facility | | $212.53 | $1,955.20 | $5,508.35 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $179.74 / $431.33 / $863.41
| Professional | | $179.74 | $431.33 | $863.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.80 / $239.48 / $260.91
| Facility | | $214.80 | $239.48 | $260.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.92 / $231.92 / $231.92
| Professional | | $231.92 | $231.92 | $231.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $344.43 / $344.43 / $344.43
| Facility | | $344.43 | $344.43 | $344.43 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $231.93 / $722.89 / $1,801.80
| Professional | | $231.93 | $722.89 | $1,801.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,384.91 / $11,384.91 / $11,384.91
| Facility | | $11,384.91 | $11,384.91 | $11,384.91 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $515.75 / $862.76 / $1,874.44
| Professional | | $515.75 | $862.76 | $1,874.44 |