- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $511.08 / $781.60 / $1,271.22
| Professional | | $511.08 | $781.60 | $1,271.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.85 / $1,426.34 / $7,393.10
| Facility | | $900.85 | $1,426.34 | $7,393.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $790.71 / $1,210.03 / $1,582.65
| Facility | | $790.71 | $1,210.03 | $1,582.65 |
- 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 |