- 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
- $524.38 / $829.16 / $1,774.32
| Professional | | $524.38 | $829.16 | $1,774.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $900.21 / $1,403.59 / $7,896.02
| Facility | | $900.21 | $1,403.59 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,029.00 / $1,512.37 / $2,961.89
| Facility | | $1,029.00 | $1,512.37 | $2,961.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,180.89 / $6,840.79 / $9,751.77
| Facility | | $4,180.89 | $6,840.79 | $9,751.77 |