- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $325.06 / $641.24 / $1,100.80
| Professional | | $325.06 | $641.24 | $1,100.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $599.89 / $1,114.93 / $8,073.49
| Facility | | $599.89 | $1,114.93 | $8,073.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $720.53 / $1,092.32 / $2,865.45
| Facility | | $720.53 | $1,092.32 | $2,865.45 |
- 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 |