- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,463.36 / $7,119.04
| Facility | | $3,496.00 | $5,463.36 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.47 / $515.88 / $1,095.04
| Professional | | $334.47 | $515.88 | $1,095.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $479.47 / $889.96 / $7,123.00
| Facility | | $479.47 | $889.96 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $677.97 / $939.51 / $2,961.89
| Facility | | $677.97 | $939.51 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |