- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $249.16 / $501.67 / $900.09
| Professional | | $249.16 | $501.67 | $900.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $410.42 / $706.37 / $1,623.00
| Facility | | $410.42 | $706.37 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $528.54 / $668.53 / $1,067.61
| Facility | | $528.54 | $668.53 | $1,067.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |