- 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
- $658.95 / $1,047.83 / $2,284.94
| Professional | | $658.95 | $1,047.83 | $2,284.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $935.30 / $1,733.22 / $11,139.12
| Facility | | $935.30 | $1,733.22 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,289.00 / $1,760.81 / $6,616.19
| Facility | | $1,289.00 | $1,760.81 | $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 |