- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $836.47 / $1,032.19 / $9,636.48
| Facility | | $836.47 | $1,032.19 | $9,636.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.47 / $836.47 / $1,032.19
| Professional | | $836.47 | $836.47 | $1,032.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $343.54 / $343.54 / $663.03
| Facility | | $343.54 | $343.54 | $663.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.54 / $343.54 / $474.08
| Professional | | $343.54 | $343.54 | $474.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,096.28 / $1,136.88 / $1,425.17
| Facility | | $1,096.28 | $1,136.88 | $1,425.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $852.66 / $1,315.54 / $1,644.42
| Professional | | $852.66 | $1,315.54 | $1,644.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $360.74 / $360.74 / $360.74
| Professional | | $360.74 | $360.74 | $360.74 |