- 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
- $198.52 / $1,139.05 / $2,130.33
| Professional | | $198.52 | $1,139.05 | $2,130.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.19 / $2,200.55 / $5,467.65
| Facility | | $523.19 | $2,200.55 | $5,467.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.63 / $1,759.36 / $2,811.20
| Facility | | $516.63 | $1,759.36 | $2,811.20 |
- 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 |