- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5.01 / $5,754.40 / $8,317.64
| Facility | | $5.01 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.04 / $1,122.02 / $1,513.56
| Professional | | $257.04 | $1,122.02 | $1,513.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $954.99 / $954.99 / $954.99
| Professional | | $954.99 | $954.99 | $954.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,466.84 / $12,302.69 / $19,054.61
| Facility | | $4,466.84 | $12,302.69 | $19,054.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,232.93 / $10,232.93 / $10,232.93
| Facility | | $10,232.93 | $10,232.93 | $10,232.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,691.53 / $3,890.45 / $3,890.45
| Professional | | $2,691.53 | $3,890.45 | $3,890.45 |