- 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
- $512.37 / $812.78 / $2,002.06
| Professional | | $512.37 | $812.78 | $2,002.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $704.56 / $1,302.73 / $4,645.00
| Facility | | $704.56 | $1,302.73 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $969.00 / $1,349.65 / $1,716.51
| Facility | | $969.00 | $1,349.65 | $1,716.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |