- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $252.72 / $644.66 / $886.73
| Professional | | $252.72 | $644.66 | $886.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $394.70 / $736.58 / $5,567.24
| Facility | | $394.70 | $736.58 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $548.91 / $1,030.16 / $2,932.27
| Facility | | $548.91 | $1,030.16 | $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 |