- 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
- $506.63 / $806.59 / $1,818.01
| Professional | | $506.63 | $806.59 | $1,818.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $842.14 / $1,296.90 / $6,036.00
| Facility | | $842.14 | $1,296.90 | $6,036.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $990.53 / $1,239.57 / $1,621.28
| Facility | | $990.53 | $1,239.57 | $1,621.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |