- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,090.00 / $11,611.47
| Facility | | $5,091.00 | $7,090.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $466.31 / $740.61 / $1,720.03
| Professional | | $466.31 | $740.61 | $1,720.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $691.06 / $1,234.40 / $6,267.00
| Facility | | $691.06 | $1,234.40 | $6,267.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $932.36 / $1,328.36 / $2,961.89
| Facility | | $932.36 | $1,328.36 | $2,961.89 |
- 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 |