- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,350.19 / $4,911.00 / $9,406.60
| Facility | | $1,350.19 | $4,911.00 | $9,406.60 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $402.40 / $710.79 / $1,246.33
| Professional | | $402.40 | $710.79 | $1,246.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $883.20 / $1,332.13 / $9,558.29
| Facility | | $883.20 | $1,332.13 | $9,558.29 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $794.00 / $1,322.33 / $3,162.53
| Facility | | $794.00 | $1,322.33 | $3,162.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |