- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,507.56 / $5,549.00 / $11,100.08
| Facility | | $2,507.56 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $263.58 / $410.49 / $1,308.22
| Professional | | $263.58 | $410.49 | $1,308.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $562.75 / $851.72 / $8,734.00
| Facility | | $562.75 | $851.72 | $8,734.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.25 / $670.35 / $851.72
| Facility | | $506.25 | $670.35 | $851.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,341.00 / $1,775.00 / $16,822.00
| Facility | | $1,341.00 | $1,775.00 | $16,822.00 |