- 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
- $433.92 / $708.23 / $1,192.61
| Professional | | $433.92 | $708.23 | $1,192.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $728.46 / $1,259.83 / $8,723.79
| Facility | | $728.46 | $1,259.83 | $8,723.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $756.00 / $1,369.87 / $2,865.45
| Facility | | $756.00 | $1,369.87 | $2,865.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,865.57 / $7,088.35 / $9,834.20
| Facility | | $4,865.57 | $7,088.35 | $9,834.20 |