- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.39 / $3,666.78 / $7,119.04
| Facility | | $2,257.39 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.28 / $320.27 / $548.36
| Professional | | $168.28 | $320.27 | $548.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.16 / $509.68 / $7,407.10
| Facility | | $351.16 | $509.68 | $7,407.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.60 / $542.82 / $3,170.91
| Facility | | $386.60 | $542.82 | $3,170.91 |
- 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 |