- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $583.03 / $4,604.83 / $7,119.04
| Facility | | $583.03 | $4,604.83 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.15 / $368.15 / $629.32
| Professional | | $193.15 | $368.15 | $629.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $395.45 / $592.20 / $8,972.49
| Facility | | $395.45 | $592.20 | $8,972.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $377.00 / $631.74 / $3,054.91
| Facility | | $377.00 | $631.74 | $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 |