- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $4,698.26 / $13,841.56
| Facility | | $2,166.29 | $4,698.26 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $626.40 / $680.00 / $3,259.25
| Professional | | $626.40 | $680.00 | $3,259.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,350.61 / $4,406.97 / $8,524.51
| Facility | | $3,350.61 | $4,406.97 | $8,524.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $298.62 / $1,242.00 / $4,406.00
| Facility | | $298.62 | $1,242.00 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |