- 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
- $162.08 / $590.89 / $824.19
| Professional | | $162.08 | $590.89 | $824.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $429.44 / $1,185.97 / $4,112.35
| Facility | | $429.44 | $1,185.97 | $4,112.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.32 / $1,162.29 / $1,625.77
| Facility | | $424.32 | $1,162.29 | $1,625.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |