- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $460.31 / $3,536.87 / $6,298.62
| Facility | | $460.31 | $3,536.87 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.32 / $227.37 / $614.57
| Professional | | $147.32 | $227.37 | $614.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $217.22 / $380.49 / $4,645.00
| Facility | | $217.22 | $380.49 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.43 / $400.29 / $1,597.11
| Facility | | $285.43 | $400.29 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |