- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $329.20 / $1,398.23 / $2,618.51
| Professional | | $329.20 | $1,398.23 | $2,618.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.41 / $2,334.78 / $8,857.49
| Facility | | $568.41 | $2,334.78 | $8,857.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $637.42 / $2,482.96 / $3,212.17
| Facility | | $637.42 | $2,482.96 | $3,212.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |