- 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
- $301.25 / $577.54 / $1,028.50
| Professional | | $301.25 | $577.54 | $1,028.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $475.95 / $822.11 / $5,567.24
| Facility | | $475.95 | $822.11 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $656.48 / $954.88 / $2,932.27
| Facility | | $656.48 | $954.88 | $2,932.27 |
- 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 |