- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $4,964.00 / $9,185.68
| Facility | | $4,146.00 | $4,964.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $281.92 / $481.40 / $842.32
| Professional | | $281.92 | $481.40 | $842.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $501.89 / $850.36 / $5,163.00
| Facility | | $501.89 | $850.36 | $5,163.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $539.00 / $930.22 / $1,331.66
| Facility | | $539.00 | $930.22 | $1,331.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,127.39 / $4,033.83 / $7,305.00
| Facility | | $2,127.39 | $4,033.83 | $7,305.00 |