- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,277.00 / $7,119.04
| Facility | | $2,906.00 | $4,277.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $411.80 / $838.43 / $1,451.23
| Professional | | $411.80 | $838.43 | $1,451.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.29 / $1,419.76 / $11,139.12
| Facility | | $540.29 | $1,419.76 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $894.99 / $1,463.09 / $9,034.41
| Facility | | $894.99 | $1,463.09 | $9,034.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |