- 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
- $356.55 / $553.58 / $1,061.94
| Professional | | $356.55 | $553.58 | $1,061.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.59 / $945.20 / $7,123.00
| Facility | | $480.59 | $945.20 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $730.39 / $967.81 / $2,961.89
| Facility | | $730.39 | $967.81 | $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 |