- 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
- $457.40 / $721.11 / $1,296.10
| Professional | | $457.40 | $721.11 | $1,296.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $683.19 / $1,315.08 / $8,586.74
| Facility | | $683.19 | $1,315.08 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $821.00 / $1,489.36 / $3,170.91
| Facility | | $821.00 | $1,489.36 | $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 |