- 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
- $46.52 / $874.66 / $1,178.81
| Professional | | $46.52 | $874.66 | $1,178.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $91.04 / $1,015.43 / $2,102.88
| Facility | | $91.04 | $1,015.43 | $2,102.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $113.20 / $916.95 / $1,869.34
| Facility | | $113.20 | $916.95 | $1,869.34 |
- 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 |