- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.18 / $3,528.00 / $7,119.04
| Facility | | $1,329.18 | $3,528.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $530.50 / $949.30 / $1,576.61
| Professional | | $530.50 | $949.30 | $1,576.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $818.24 / $1,484.86 / $7,123.00
| Facility | | $818.24 | $1,484.86 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,089.00 / $1,753.68 / $2,403.80
| Facility | | $1,089.00 | $1,753.68 | $2,403.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |