- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,977.00 / $4,235.59 / $7,119.04
| Facility | | $2,977.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.34 / $984.24 / $2,221.87
| Professional | | $626.34 | $984.24 | $2,221.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,035.05 / $1,660.97 / $7,896.02
| Facility | | $1,035.05 | $1,660.97 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,211.58 / $1,658.15 / $2,961.89
| Facility | | $1,211.58 | $1,658.15 | $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 |