- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,498.40
| Facility | | $3,496.00 | $5,091.00 | $7,498.40 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $497.18 / $860.84 / $2,282.78
| Professional | | $497.18 | $860.84 | $2,282.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.43 / $1,329.36 / $7,896.02
| Facility | | $847.43 | $1,329.36 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $995.00 / $1,328.57 / $2,961.89
| Facility | | $995.00 | $1,328.57 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.89 / $6,840.79 / $9,751.77
| Facility | | $4,180.89 | $6,840.79 | $9,751.77 |