- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,421.00 / $5,463.36 / $7,119.04
| Facility | | $3,421.00 | $5,463.36 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $246.43 / $364.27 / $940.94
| Professional | | $246.43 | $364.27 | $940.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $348.06 / $635.02 / $4,871.77
| Facility | | $348.06 | $635.02 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.43 / $825.92 / $1,622.05
| Facility | | $495.43 | $825.92 | $1,622.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |