- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $338.84 / $7,943.28 / $11,481.54
| Facility | | $338.84 | $7,943.28 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $446.68 / $933.25
| Professional | | $331.13 | $446.68 | $933.25 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $467.74 / $660.69
| Professional | | $346.74 | $467.74 | $660.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,456.54 / $6,456.54 / $6,456.54
| Facility | | $6,456.54 | $6,456.54 | $6,456.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.59 / $426.58 / $645.65
| Professional | | $323.59 | $426.58 | $645.65 |