- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.19 / $4,604.83 / $8,042.03
| Facility | | $3,027.19 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $223.05 / $436.87 / $776.04
| Professional | | $223.05 | $436.87 | $776.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $353.40 / $668.17 / $5,497.82
| Facility | | $353.40 | $668.17 | $5,497.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $537.79 / $904.24 / $1,913.58
| Facility | | $537.79 | $904.24 | $1,913.58 |
- 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 |