- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $284.24 / $501.01 / $968.40
| Professional | | $284.24 | $501.01 | $968.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.48 / $809.47 / $8,586.74
| Facility | | $506.48 | $809.47 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $616.00 / $933.35 / $3,170.91
| Facility | | $616.00 | $933.35 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |