- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,560.18 / $4,911.00 / $9,185.68
| Facility | | $3,560.18 | $4,911.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $827.02 / $1,423.29 / $2,390.23
| Professional | | $827.02 | $1,423.29 | $2,390.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,539.70 / $2,205.04 / $7,300.58
| Facility | | $1,539.70 | $2,205.04 | $7,300.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,382.31 / $2,000.50 / $2,728.76
| Facility | | $1,382.31 | $2,000.50 | $2,728.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |