- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $896.67 / $6,404.52 / $9,643.59
| Facility | | $896.67 | $6,404.52 | $9,643.59 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $342.46 / $849.40 / $948.73
| Professional | | $342.46 | $849.40 | $948.73 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $352.56 / $635.88 / $1,548.30
| Professional | | $352.56 | $635.88 | $1,548.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,150.78 / $7,150.78 / $15,678.26
| Facility | | $7,150.78 | $7,150.78 | $15,678.26 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $860.29 / $1,392.68 / $1,982.41
| Professional | | $860.29 | $1,392.68 | $1,982.41 |