- 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
- $555.07 / $919.10 / $1,643.46
| Professional | | $555.07 | $919.10 | $1,643.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $870.02 / $1,416.40 / $5,059.28
| Facility | | $870.02 | $1,416.40 | $5,059.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,158.35 / $1,439.37 / $2,932.27
| Facility | | $1,158.35 | $1,439.37 | $2,932.27 |
- 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 |