- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,778.89 / $12,765.09
| Facility | | $2,906.00 | $4,778.89 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $471.28 / $738.08 / $1,616.75
| Professional | | $471.28 | $738.08 | $1,616.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $666.30 / $1,242.60 / $7,896.02
| Facility | | $666.30 | $1,242.60 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $927.02 / $1,355.29 / $2,961.89
| Facility | | $927.02 | $1,355.29 | $2,961.89 |
- 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 |