- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,966.66 / $4,911.00 / $11,753.48
| Facility | | $2,966.66 | $4,911.00 | $11,753.48 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $467.71 / $715.19 / $1,461.82
| Professional | | $467.71 | $715.19 | $1,461.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.74 / $1,180.38 / $7,123.00
| Facility | | $508.74 | $1,180.38 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $797.95 / $1,285.00 / $2,961.89
| Facility | | $797.95 | $1,285.00 | $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 |