- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $191.13 / $439.96 / $1,011.04
| Professional | | $191.13 | $439.96 | $1,011.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $317.39 / $572.90 / $8,909.26
| Facility | | $317.39 | $572.90 | $8,909.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $469.34 / $830.43 / $3,908.14
| Facility | | $469.34 | $830.43 | $3,908.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |