- 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
- $258.73 / $406.58 / $1,035.46
| Professional | | $258.73 | $406.58 | $1,035.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.54 / $710.83 / $7,123.00
| Facility | | $429.54 | $710.83 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.00 / $724.33 / $2,961.89
| Facility | | $552.00 | $724.33 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.89 / $6,006.07 / $8,514.60
| Facility | | $4,180.89 | $6,006.07 | $8,514.60 |