- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,671.00 / $3,617.00 / $6,329.00
| Facility | | $1,671.00 | $3,617.00 | $6,329.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $655.61 / $1,240.00 / $1,383.34
| Professional | | $655.61 | $1,240.00 | $1,383.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.92 / $1,704.86 / $2,700.74
| Facility | | $448.92 | $1,704.86 | $2,700.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $694.95 / $1,712.00 / $3,763.00
| Facility | | $694.95 | $1,712.00 | $3,763.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,578.00 / $2,522.00 / $5,029.00
| Facility | | $1,578.00 | $2,522.00 | $5,029.00 |