- 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
- $425.76 / $603.13 / $1,203.16
| Professional | | $425.76 | $603.13 | $1,203.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $692.18 / $1,319.02 / $6,945.09
| Facility | | $692.18 | $1,319.02 | $6,945.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $738.00 / $1,434.35 / $2,428.62
| Facility | | $738.00 | $1,434.35 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |