- 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
- $766.50 / $1,354.42 / $2,192.98
| Professional | | $766.50 | $1,354.42 | $2,192.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.83 / $1,869.15 / $5,023.00
| Facility | | $786.83 | $1,869.15 | $5,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,265.11 / $1,812.22 / $2,497.00
| Facility | | $1,265.11 | $1,812.22 | $2,497.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,679.00 / $5,023.00 / $7,305.00
| Facility | | $2,679.00 | $5,023.00 | $7,305.00 |