- 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
- $224.63 / $1,047.48 / $1,733.16
| Professional | | $224.63 | $1,047.48 | $1,733.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $347.99 / $1,235.54 / $2,126.00
| Facility | | $347.99 | $1,235.54 | $2,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $435.63 / $1,529.45 / $2,707.21
| Facility | | $435.63 | $1,529.45 | $2,707.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |