- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $985.98 / $5,761.78 / $8,042.03
| Facility | | $985.98 | $5,761.78 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $303.02 / $479.67 / $1,062.70
| Professional | | $303.02 | $479.67 | $1,062.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $513.23 / $815.01 / $4,873.45
| Facility | | $513.23 | $815.01 | $4,873.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $612.66 / $858.83 / $1,597.11
| Facility | | $612.66 | $858.83 | $1,597.11 |
- 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 |