- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,421.00 / $4,604.83 / $8,042.03
| Facility | | $3,421.00 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $462.01 / $785.23 / $1,355.10
| Professional | | $462.01 | $785.23 | $1,355.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $676.43 / $1,302.34 / $8,165.52
| Facility | | $676.43 | $1,302.34 | $8,165.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $834.00 / $1,454.56 / $3,093.19
| Facility | | $834.00 | $1,454.56 | $3,093.19 |
- 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 |