- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,182.89 / $3,666.78 / $7,119.04
| Facility | | $1,182.89 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $132.94 / $248.64 / $414.73
| Professional | | $132.94 | $248.64 | $414.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.86 / $405.85 / $8,972.49
| Facility | | $265.86 | $405.85 | $8,972.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.00 / $431.99 / $3,054.91
| Facility | | $250.00 | $431.99 | $3,054.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |