- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $7,119.04
| Facility | | $3,496.00 | $5,091.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $394.30 / $582.48 / $1,499.66
| Professional | | $394.30 | $582.48 | $1,499.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.25 / $1,026.31 / $7,155.00
| Facility | | $563.25 | $1,026.31 | $7,155.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $793.08 / $1,321.28 / $3,508.23
| Facility | | $793.08 | $1,321.28 | $3,508.23 |
- 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 |