- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $167.61 / $551.37 / $1,246.27
| Professional | | $167.61 | $551.37 | $1,246.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $404.57 / $881.78 / $5,260.89
| Facility | | $404.57 | $881.78 | $5,260.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $417.76 / $958.64 / $1,813.25
| Facility | | $417.76 | $958.64 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |