- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,269.14 / $4,033.00 / $9,248.33
| Facility | | $1,269.14 | $4,033.00 | $9,248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $414.51 / $774.40 / $1,252.15
| Professional | | $414.51 | $774.40 | $1,252.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.93 / $1,165.33 / $7,123.00
| Facility | | $662.93 | $1,165.33 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $867.67 / $1,397.38 / $2,256.42
| Facility | | $867.67 | $1,397.38 | $2,256.42 |
- 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 |