- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $3,795.64 / $7,119.04
| Facility | | $2,234.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $178.78 / $1,398.17 / $3,211.26
| Professional | | $178.78 | $1,398.17 | $3,211.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $294.95 / $856.35 / $5,516.41
| Facility | | $294.95 | $856.35 | $5,516.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $351.25 / $1,193.67 / $6,569.28
| Facility | | $351.25 | $1,193.67 | $6,569.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |