- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.16 / $5,463.36 / $7,119.04
| Facility | | $695.16 | $5,463.36 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $67.84 / $112.65 / $817.50
| Professional | | $67.84 | $112.65 | $817.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.93 / $184.15 / $2,711.04
| Facility | | $104.93 | $184.15 | $2,711.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $138.16 / $184.15 / $1,216.72
| Facility | | $138.16 | $184.15 | $1,216.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |