- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $977.24 / $2,818.38 / $7,762.47
| Facility | | $977.24 | $2,818.38 | $7,762.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $74.13 / $346.74 / $2,691.53
| Professional | | $74.13 | $346.74 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.08 / $1,819.70 / $4,168.69
| Facility | | $676.08 | $1,819.70 | $4,168.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $575.44 / $1,288.25
| Facility | | $54.95 | $575.44 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $151.36 / $691.83 / $1,380.38
| Facility | | $151.36 | $691.83 | $1,380.38 |