- 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
- $282.17 / $547.28 / $1,060.57
| Professional | | $282.17 | $547.28 | $1,060.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $605.52 / $909.92 / $5,847.00
| Facility | | $605.52 | $909.92 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $662.29 / $926.03 / $3,170.91
| Facility | | $662.29 | $926.03 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |