- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $3,981.07 / $6,760.83
| Facility | | $954.99 | $3,981.07 | $6,760.83 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $549.54 / $851.14 / $2,041.74
| Professional | | $549.54 | $851.14 | $2,041.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.99 / $1,621.81 / $17,782.79
| Facility | | $954.99 | $1,621.81 | $17,782.79 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,258.93 / $1,445.44 / $1,659.59
| Professional | | $1,258.93 | $1,445.44 | $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 |