- 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
- $325.12 / $499.26 / $1,316.20
| Professional | | $325.12 | $499.26 | $1,316.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $433.32 / $852.47 / $7,123.00
| Facility | | $433.32 | $852.47 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $655.14 / $915.48 / $2,961.89
| Facility | | $655.14 | $915.48 | $2,961.89 |
- 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 |