- 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
- $474.03 / $751.35 / $1,583.64
| Professional | | $474.03 | $751.35 | $1,583.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $715.82 / $1,275.11 / $7,123.00
| Facility | | $715.82 | $1,275.11 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $953.00 / $1,343.73 / $2,961.89
| Facility | | $953.00 | $1,343.73 | $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 |