- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $5,248.07 / $13,489.63
| Facility | | $954.99 | $5,248.07 | $13,489.63 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $575.44 / $912.01 / $2,691.53
| Professional | | $575.44 | $912.01 | $2,691.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $891.25 / $1,479.11 / $9,772.37
| Facility | | $891.25 | $1,479.11 | $9,772.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,348.96 / $1,479.11 / $1,659.59
| Professional | | $1,348.96 | $1,479.11 | $1,659.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,511.38 / $11,748.98 / $19,498.45
| Facility | | $8,511.38 | $11,748.98 | $19,498.45 |