- 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
- $374.91 / $593.78 / $1,314.85
| Professional | | $374.91 | $593.78 | $1,314.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $568.37 / $1,008.22 / $7,896.02
| Facility | | $568.37 | $1,008.22 | $7,896.02 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.38 / $1,058.20 / $2,961.89
| Facility | | $757.38 | $1,058.20 | $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 |