- 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
- $301.08 / $460.43 / $1,153.30
| Professional | | $301.08 | $460.43 | $1,153.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $510.13 / $809.87 / $4,645.00
| Facility | | $510.13 | $809.87 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.46 / $843.62 / $1,597.11
| Facility | | $608.46 | $843.62 | $1,597.11 |
- 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 |