- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $213.76 / $488.07 / $1,038.38
| Professional | | $213.76 | $488.07 | $1,038.38 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $337.91 / $642.00 / $5,321.00
| Facility | | $337.91 | $642.00 | $5,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $481.07 / $803.41 / $2,197.38
| Facility | | $481.07 | $803.41 | $2,197.38 |
- 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 |