- 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
- $88.27 / $1,560.32 / $2,517.40
| Professional | | $88.27 | $1,560.32 | $2,517.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $231.86 / $3,006.26 / $10,508.52
| Facility | | $231.86 | $3,006.26 | $10,508.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.68 / $3,249.51 / $4,779.05
| Facility | | $237.68 | $3,249.51 | $4,779.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |