- 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
- $527.40 / $846.36 / $2,105.35
| Professional | | $527.40 | $846.36 | $2,105.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $877.13 / $1,422.14 / $11,139.12
| Facility | | $877.13 | $1,422.14 | $11,139.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.55 / $1,455.82 / $9,022.12
| Facility | | $1,029.55 | $1,455.82 | $9,022.12 |
- 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 |