- 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
- $474.69 / $725.63 / $1,589.60
| Professional | | $474.69 | $725.63 | $1,589.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $473.05 / $1,177.10 / $5,301.00
| Facility | | $473.05 | $1,177.10 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $758.13 / $1,274.66 / $1,750.65
| Facility | | $758.13 | $1,274.66 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,564.02 / $4,898.00 / $7,155.00
| Facility | | $2,564.02 | $4,898.00 | $7,155.00 |