- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $759.17 / $1,748.74 / $6,298.62
| Facility | | $759.17 | $1,748.74 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $228.13 / $423.12 / $771.37
| Professional | | $228.13 | $423.12 | $771.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $319.64 / $615.73 / $1,838.54
| Facility | | $319.64 | $615.73 | $1,838.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $442.32 / $761.09 / $1,156.80
| Facility | | $442.32 | $761.09 | $1,156.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |