- 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
- $345.59 / $658.70 / $1,161.93
| Professional | | $345.59 | $658.70 | $1,161.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $556.41 / $967.70 / $5,567.24
| Facility | | $556.41 | $967.70 | $5,567.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.18 / $1,083.69 / $2,932.27
| Facility | | $756.18 | $1,083.69 | $2,932.27 |
- 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 |