- 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
- $208.71 / $1,244.46 / $2,376.96
| Professional | | $208.71 | $1,244.46 | $2,376.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $552.83 / $2,047.30 / $5,467.65
| Facility | | $552.83 | $2,047.30 | $5,467.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.65 / $1,679.79 / $2,429.96
| Facility | | $547.65 | $1,679.79 | $2,429.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |