- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,462.10 / $3,822.84 / $7,119.04
| Facility | | $1,462.10 | $3,822.84 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $421.27 / $622.04 / $1,587.23
| Professional | | $421.27 | $622.04 | $1,587.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $597.16 / $1,097.06 / $8,625.21
| Facility | | $597.16 | $1,097.06 | $8,625.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $847.13 / $1,410.96 / $6,472.01
| Facility | | $847.13 | $1,410.96 | $6,472.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $5,327.00 / $8,342.00
| Facility | | $1,770.00 | $5,327.00 | $8,342.00 |