- 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
- $330.22 / $467.18 / $800.58
| Professional | | $330.22 | $467.18 | $800.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $545.00 / $1,012.34 / $7,104.12
| Facility | | $545.00 | $1,012.34 | $7,104.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $675.97 / $1,109.57 / $2,052.00
| Facility | | $675.97 | $1,109.57 | $2,052.00 |
- 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 |