- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,027.19 / $4,604.83 / $8,042.03
| Facility | | $3,027.19 | $4,604.83 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $334.97 / $508.91 / $1,269.76
| Professional | | $334.97 | $508.91 | $1,269.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $520.73 / $1,011.60 / $11,051.00
| Facility | | $520.73 | $1,011.60 | $11,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.15 / $780.37 / $1,020.68
| Facility | | $523.15 | $780.37 | $1,020.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,778.43 / $8,847.00 / $53,736.00
| Facility | | $4,778.43 | $8,847.00 | $53,736.00 |