- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,778.89 / $7,119.04
| Facility | | $2,906.00 | $4,778.89 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $762.05 / $1,142.73 / $3,585.16
| Professional | | $762.05 | $1,142.73 | $3,585.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $968.36 / $1,481.11 / $8,625.21
| Facility | | $968.36 | $1,481.11 | $8,625.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,285.69 / $1,691.74 / $2,440.25
| Facility | | $1,285.69 | $1,691.74 | $2,440.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $5,327.00 / $8,342.00
| Facility | | $1,770.00 | $5,327.00 | $8,342.00 |