- 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
- $158.35 / $1,050.14 / $1,701.60
| Professional | | $158.35 | $1,050.14 | $1,701.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $385.14 / $1,557.12 / $2,357.67
| Facility | | $385.14 | $1,557.12 | $2,357.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $403.89 / $1,743.00 / $2,377.10
| Facility | | $403.89 | $1,743.00 | $2,377.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |