- 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
- $185.28 / $431.31 / $1,038.10
| Professional | | $185.28 | $431.31 | $1,038.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.08 / $657.30 / $3,984.48
| Facility | | $294.08 | $657.30 | $3,984.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $405.38 / $794.52 / $1,597.11
| Facility | | $405.38 | $794.52 | $1,597.11 |
- 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 |