- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $486.01 / $2,834.13 / $10,327.15
| Facility | | $486.01 | $2,834.13 | $10,327.15 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.47 / $400.89 / $637.05
| Professional | | $157.47 | $400.89 | $637.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $255.80 / $471.22 / $2,314.36
| Facility | | $255.80 | $471.22 | $2,314.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.40 / $436.00 / $791.43
| Facility | | $347.40 | $436.00 | $791.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |