- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,300.00 / $3,259.25 / $7,119.04
| Facility | | $1,300.00 | $3,259.25 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $279.86 / $482.42 / $2,431.84
| Professional | | $279.86 | $482.42 | $2,431.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $524.70 / $886.74 / $8,369.10
| Facility | | $524.70 | $886.74 | $8,369.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $646.00 / $945.18 / $3,701.41
| Facility | | $646.00 | $945.18 | $3,701.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |