- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,175.25 / $3,489.13 / $6,446.00
| Facility | | $1,175.25 | $3,489.13 | $6,446.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $181.66 / $344.90 / $603.53
| Professional | | $181.66 | $344.90 | $603.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $384.11 / $560.47 / $9,495.24
| Facility | | $384.11 | $560.47 | $9,495.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $365.00 / $603.79 / $3,054.91
| Facility | | $365.00 | $603.79 | $3,054.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |