- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,917.20 / $7,119.04
| Facility | | $3,496.00 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $362.09 / $726.71 / $1,312.20
| Professional | | $362.09 | $726.71 | $1,312.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.87 / $1,004.04 / $5,567.24
| Facility | | $566.87 | $1,004.04 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $802.76 / $1,184.84 / $2,932.27
| Facility | | $802.76 | $1,184.84 | $2,932.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.89 / $6,006.07 / $8,514.60
| Facility | | $4,180.89 | $6,006.07 | $8,514.60 |