- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $851.14 / $8,511.38
| Facility | | $331.13 | $851.14 | $8,511.38 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $331.13 / $1,096.48 / $25,118.86
| Professional | | $331.13 | $1,096.48 | $25,118.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $812.83 / $1,096.48
| Facility | | $331.13 | $812.83 | $1,096.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $151.36 / $616.60 / $1,548.82
| Professional | | $151.36 | $616.60 | $1,548.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.70 / $2,041.74 / $2,041.74
| Facility | | $1,819.70 | $2,041.74 | $2,041.74 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $173.78 / $630.96 / $1,258.93
| Professional | | $173.78 | $630.96 | $1,258.93 |