- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,909.48 / $13,841.56
| Facility | | $2,166.29 | $5,909.48 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $657.95 / $2,268.00 / $4,619.16
| Professional | | $657.95 | $2,268.00 | $4,619.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.62 / $1,242.00 / $13,286.40
| Facility | | $298.62 | $1,242.00 | $13,286.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,056.00 / $1,527.00 / $4,317.00
| Facility | | $1,056.00 | $1,527.00 | $4,317.00 |