- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,724.00 / $10,431.19 / $21,899.37
| Facility | | $5,724.00 | $10,431.19 | $21,899.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $576.89 / $2,086.46 / $4,168.32
| Professional | | $576.89 | $2,086.46 | $4,168.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,896.99 / $5,281.43 / $9,914.59
| Facility | | $3,896.99 | $5,281.43 | $9,914.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,677.51 / $8,632.00 / $9,719.69
| Facility | | $2,677.51 | $8,632.00 | $9,719.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |