- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.13 / $5,754.40 / $8,317.64
| Facility | | $331.13 | $5,754.40 | $8,317.64 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $346.74 / $346.74 / $467.74
| Professional | | $346.74 | $346.74 | $467.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.42 / $363.08 / $562.34
| Facility | | $234.42 | $363.08 | $562.34 |
- 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 |