- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $503.93 / $720.71 / $1,453.23
| Professional | | $503.93 | $720.71 | $1,453.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $800.24 / $1,444.10 / $6,945.09
| Facility | | $800.24 | $1,444.10 | $6,945.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $954.82 / $1,568.35 / $2,428.62
| Facility | | $954.82 | $1,568.35 | $2,428.62 |
- 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 |