- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $225.48 / $378.76 / $2,822.83
| Professional | | $225.48 | $378.76 | $2,822.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $331.52 / $569.71 / $1,607.00
| Facility | | $331.52 | $569.71 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $420.43 / $541.49 / $699.90
| Facility | | $420.43 | $541.49 | $699.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,775.00 / $3,560.25
| Facility | | $1,204.00 | $1,775.00 | $3,560.25 |