- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $1,513.56 / $9,549.93
| Facility | | $331.13 | $1,513.56 | $9,549.93 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $380.19 / $380.19 / $489.78
| Professional | | $380.19 | $380.19 | $489.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.47 / $380.19 / $575.44
| Facility | | $245.47 | $380.19 | $575.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,187.76 / $7,244.36 / $10,471.29
| Facility | | $2,187.76 | $7,244.36 | $10,471.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,760.83 / $6,760.83 / $28,840.32
| Facility | | $6,760.83 | $6,760.83 | $28,840.32 |