- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $8,300.34
| Facility | | $4,146.00 | $5,091.00 | $8,300.34 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $364.84 / $578.49 / $1,257.91
| Professional | | $364.84 | $578.49 | $1,257.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $565.01 / $977.34 / $4,873.45
| Facility | | $565.01 | $977.34 | $4,873.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $733.67 / $1,033.08 / $1,597.11
| Facility | | $733.67 | $1,033.08 | $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 |