- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,292.35 / $3,666.78 / $7,119.04
| Facility | | $1,292.35 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $393.40 / $622.79 / $1,212.89
| Professional | | $393.40 | $622.79 | $1,212.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $588.65 / $1,047.49 / $7,123.00
| Facility | | $588.65 | $1,047.49 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $799.55 / $1,118.83 / $2,961.89
| Facility | | $799.55 | $1,118.83 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |