- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,576.03 / $4,917.20 / $7,119.04
| Facility | | $1,576.03 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $681.40 / $1,084.09 / $2,355.60
| Professional | | $681.40 | $1,084.09 | $2,355.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,128.88 / $1,807.06 / $20,063.05
| Facility | | $1,128.88 | $1,807.06 | $20,063.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,356.39 / $1,810.95 / $16,004.24
| Facility | | $1,356.39 | $1,810.95 | $16,004.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |