- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $350.19 / $667.15 / $1,307.25
| Professional | | $350.19 | $667.15 | $1,307.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $549.12 / $961.03 / $6,616.19
| Facility | | $549.12 | $961.03 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.28 / $1,113.53 / $6,466.51
| Facility | | $769.28 | $1,113.53 | $6,466.51 |
- 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 |