- 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
- $500.01 / $832.28 / $1,487.61
| Professional | | $500.01 | $832.28 | $1,487.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $885.89 / $1,426.78 / $8,586.74
| Facility | | $885.89 | $1,426.78 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $922.00 / $1,641.42 / $3,170.91
| Facility | | $922.00 | $1,641.42 | $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 |