- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $282.01 / $2,050.65 / $6,298.62
| Facility | | $282.01 | $2,050.65 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.31 / $772.33 / $983.55
| Professional | | $81.31 | $772.33 | $983.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $162.93 / $1,017.36 / $2,102.88
| Facility | | $162.93 | $1,017.36 | $2,102.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $214.01 / $916.95 / $1,790.27
| Facility | | $214.01 | $916.95 | $1,790.27 |
- 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 |