- 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
- $706.39 / $1,131.68 / $3,503.62
| Professional | | $706.39 | $1,131.68 | $3,503.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,186.15 / $1,903.28 / $11,139.12
| Facility | | $1,186.15 | $1,903.28 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,361.02 / $1,823.74 / $6,616.19
| Facility | | $1,361.02 | $1,823.74 | $6,616.19 |
- 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 |