- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.00 / $3,666.78 / $7,119.04
| Facility | | $2,833.00 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $153.16 / $585.08 / $1,158.15
| Professional | | $153.16 | $585.08 | $1,158.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $381.93 / $1,049.00 / $7,407.10
| Facility | | $381.93 | $1,049.00 | $7,407.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $390.69 / $1,101.35 / $3,170.91
| Facility | | $390.69 | $1,101.35 | $3,170.91 |
- 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 |