- 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
- $467.41 / $743.15 / $1,571.73
| Professional | | $467.41 | $743.15 | $1,571.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $723.70 / $1,243.93 / $11,139.12
| Facility | | $723.70 | $1,243.93 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $937.00 / $1,337.33 / $6,616.19
| Facility | | $937.00 | $1,337.33 | $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 |