- 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
- $276.41 / $439.83 / $1,002.24
| Professional | | $276.41 | $439.83 | $1,002.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.78 / $683.54 / $7,123.00
| Facility | | $355.78 | $683.54 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $532.69 / $668.12 / $898.93
| Facility | | $532.69 | $668.12 | $898.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |