- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,964.00 / $8,042.03
| Facility | | $3,468.00 | $4,964.00 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $439.18 / $655.04 / $1,544.14
| Professional | | $439.18 | $655.04 | $1,544.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.17 / $1,156.02 / $6,306.00
| Facility | | $540.17 | $1,156.02 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $810.53 / $1,024.86 / $1,360.90
| Facility | | $810.53 | $1,024.86 | $1,360.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |