- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.84 / $1,050.69 / $9,906.53
| Facility | | $377.84 | $1,050.69 | $9,906.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $300.69 / $353.51 / $408.83
| Professional | | $300.69 | $353.51 | $408.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $396.90 / $479.96 / $576.79
| Professional | | $396.90 | $479.96 | $576.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,982.36 / $5,982.36 / $5,982.36
| Facility | | $5,982.36 | $5,982.36 | $5,982.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $340.11 / $431.40 / $931.71
| Professional | | $340.11 | $431.40 | $931.71 |