- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,025.58 / $2,912.34 / $6,298.62
| Facility | | $1,025.58 | $2,912.34 | $6,298.62 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $343.16 / $607.05 / $1,238.05
| Professional | | $343.16 | $607.05 | $1,238.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.78 / $895.74 / $3,396.00
| Facility | | $539.78 | $895.74 | $3,396.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $767.84 / $966.56 / $1,597.11
| Facility | | $767.84 | $966.56 | $1,597.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |