- 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
- $230.72 / $1,525.37 / $2,197.79
| Professional | | $230.72 | $1,525.37 | $2,197.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $402.52 / $1,775.00 / $3,353.16
| Facility | | $402.52 | $1,775.00 | $3,353.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $533.23 / $2,195.57 / $3,754.71
| Facility | | $533.23 | $2,195.57 | $3,754.71 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,623.00 / $2,126.00
| Facility | | $1,026.00 | $1,623.00 | $2,126.00 |