- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,463.36 / $10,563.53
| Facility | | $4,146.00 | $5,463.36 | $10,563.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $339.98 / $674.43 / $1,180.74
| Professional | | $339.98 | $674.43 | $1,180.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.10 / $934.59 / $6,616.19
| Facility | | $533.10 | $934.59 | $6,616.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $748.91 / $1,105.52 / $6,466.51
| Facility | | $748.91 | $1,105.52 | $6,466.51 |
- 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 |