- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $516.45 / $820.05 / $1,972.93
| Professional | | $516.45 | $820.05 | $1,972.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.60 / $1,367.13 / $7,896.02
| Facility | | $758.60 | $1,367.13 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,032.33 / $1,470.17 / $2,961.89
| Facility | | $1,032.33 | $1,470.17 | $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 |