- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,172.55 / $4,917.20 / $7,119.04
| Facility | | $3,172.55 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $420.58 / $660.91 / $2,179.92
| Professional | | $420.58 | $660.91 | $2,179.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $695.24 / $1,158.73 / $7,896.02
| Facility | | $695.24 | $1,158.73 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.00 / $1,216.91 / $2,961.89
| Facility | | $937.00 | $1,216.91 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |