- 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
- $362.50 / $556.16 / $933.99
| Professional | | $362.50 | $556.16 | $933.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.60 / $977.66 / $5,321.00
| Facility | | $507.60 | $977.66 | $5,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $741.00 / $1,009.27 / $1,750.65
| Facility | | $741.00 | $1,009.27 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,854.53 / $7,407.10
| Facility | | $3,711.00 | $5,854.53 | $7,407.10 |