- 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
- $483.14 / $682.52 / $1,133.81
| Professional | | $483.14 | $682.52 | $1,133.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $708.00 / $1,390.77 / $14,525.55
| Facility | | $708.00 | $1,390.77 | $14,525.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $786.30 / $1,522.00 / $5,275.65
| Facility | | $786.30 | $1,522.00 | $5,275.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |