- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,312.10 / $2,912.34 / $7,119.04
| Facility | | $1,312.10 | $2,912.34 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $387.91 / $602.67 / $1,378.75
| Professional | | $387.91 | $602.67 | $1,378.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $530.11 / $1,068.84 / $4,645.00
| Facility | | $530.11 | $1,068.84 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.40 / $1,114.08 / $1,597.11
| Facility | | $818.40 | $1,114.08 | $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 |