- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $372.83 / $581.00 / $1,188.34
| Professional | | $372.83 | $581.00 | $1,188.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $504.23 / $962.44 / $5,301.00
| Facility | | $504.23 | $962.44 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $753.92 / $1,033.98 / $1,750.65
| Facility | | $753.92 | $1,033.98 | $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 |