- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,257.39 / $3,666.78 / $7,119.04
| Facility | | $2,257.39 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $377.46 / $599.05 / $1,408.85
| Professional | | $377.46 | $599.05 | $1,408.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $581.61 / $982.92 / $5,301.00
| Facility | | $581.61 | $982.92 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.43 / $1,075.16 / $1,750.65
| Facility | | $758.43 | $1,075.16 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,854.53 / $7,407.10
| Facility | | $3,711.00 | $5,854.53 | $7,407.10 |