- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $594.47 / $6,775.83 / $8,373.42
| Facility | | $594.47 | $6,775.83 | $8,373.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $448.87 / $537.49 / $567.54
| Professional | | $448.87 | $537.49 | $567.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.19 / $651.22 / $882.58
| Professional | | $503.19 | $651.22 | $882.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,838.62 / $6,132.00 / $10,792.49
| Facility | | $3,838.62 | $6,132.00 | $10,792.49 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.96 / $622.77 / $1,260.21
| Professional | | $471.96 | $622.77 | $1,260.21 |