- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,559.52 / $5,463.36 / $7,119.04
| Facility | | $3,559.52 | $5,463.36 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $299.50 / $534.90 / $1,626.14
| Professional | | $299.50 | $534.90 | $1,626.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $525.00 / $844.35 / $7,915.44
| Facility | | $525.00 | $844.35 | $7,915.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $517.05 / $812.75 / $1,016.76
| Facility | | $517.05 | $812.75 | $1,016.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $6,588.00 / $10,320.00
| Facility | | $1,770.00 | $6,588.00 | $10,320.00 |