- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $359.23 / $5,777.60 / $9,717.87
| Facility | | $359.23 | $5,777.60 | $9,717.87 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.83 / $348.62 / $486.72
| Professional | | $321.83 | $348.62 | $486.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $324.73 / $530.64 / $802.89
| Professional | | $324.73 | $530.64 | $802.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,255.14 / $10,094.54 / $16,622.11
| Facility | | $2,255.14 | $10,094.54 | $16,622.11 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.93 / $634.85 / $827.69
| Professional | | $420.93 | $634.85 | $827.69 |