- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,042.74 / $3,489.13 / $7,119.04
| Facility | | $1,042.74 | $3,489.13 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $257.98 / $413.97 / $1,538.45
| Professional | | $257.98 | $413.97 | $1,538.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $386.34 / $696.57 / $5,301.00
| Facility | | $386.34 | $696.57 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $554.00 / $719.52 / $1,750.65
| Facility | | $554.00 | $719.52 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |