- 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
- $393.37 / $607.37 / $1,543.68
| Professional | | $393.37 | $607.37 | $1,543.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $502.32 / $1,038.09 / $7,123.00
| Facility | | $502.32 | $1,038.09 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.00 / $1,076.66 / $1,249.31
| Facility | | $692.00 | $1,076.66 | $1,249.31 |
- 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 |