- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.98 / $4,604.83 / $7,119.04
| Facility | | $863.98 | $4,604.83 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.39 / $534.82 / $902.72
| Professional | | $343.39 | $534.82 | $902.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $465.96 / $960.81 / $12,013.25
| Facility | | $465.96 | $960.81 | $12,013.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $584.00 / $1,054.66 / $4,164.35
| Facility | | $584.00 | $1,054.66 | $4,164.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $6,110.41 / $8,342.00
| Facility | | $3,711.00 | $6,110.41 | $8,342.00 |