- 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
- $223.16 / $345.75 / $898.56
| Professional | | $223.16 | $345.75 | $898.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $335.25 / $1,207.40 / $4,730.41
| Facility | | $335.25 | $1,207.40 | $4,730.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $409.47 / $835.89 / $1,264.80
| Facility | | $409.47 | $835.89 | $1,264.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |