- 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
- $219.37 / $378.15 / $907.61
| Professional | | $219.37 | $378.15 | $907.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.31 / $561.60 / $1,607.00
| Facility | | $332.31 | $561.60 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.69 / $556.57 / $731.03
| Facility | | $422.69 | $556.57 | $731.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |