- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,498.51 / $4,277.00 / $7,119.04
| Facility | | $1,498.51 | $4,277.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.40 / $820.58 / $2,184.79
| Professional | | $480.40 | $820.58 | $2,184.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $788.69 / $1,283.69 / $7,896.02
| Facility | | $788.69 | $1,283.69 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $967.00 / $1,316.00 / $2,961.89
| Facility | | $967.00 | $1,316.00 | $2,961.89 |
- 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 |