- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,731.68 / $4,911.00 / $7,120.36
| Facility | | $2,731.68 | $4,911.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $250.36 / $409.29 / $1,136.08
| Professional | | $250.36 | $409.29 | $1,136.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.49 / $649.94 / $1,607.00
| Facility | | $419.49 | $649.94 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.62 / $625.19 / $826.97
| Facility | | $484.62 | $625.19 | $826.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |