- 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
- $472.80 / $749.52 / $1,706.79
| Professional | | $472.80 | $749.52 | $1,706.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $685.43 / $1,246.04 / $4,645.00
| Facility | | $685.43 | $1,246.04 | $4,645.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $950.61 / $1,266.75 / $1,597.29
| Facility | | $950.61 | $1,266.75 | $1,597.29 |
- 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 |