- 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
- $309.02 / $469.82 / $1,094.40
| Professional | | $309.02 | $469.82 | $1,094.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $507.86 / $3,239.20 / $9,495.24
| Facility | | $507.86 | $3,239.20 | $9,495.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $698.45 / $1,023.02 / $3,828.14
| Facility | | $698.45 | $1,023.02 | $3,828.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |