- 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
- $905.43 / $1,541.30 / $2,656.17
| Professional | | $905.43 | $1,541.30 | $2,656.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,500.31 / $2,590.54 / $12,371.41
| Facility | | $1,500.31 | $2,590.54 | $12,371.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,688.00 / $2,988.75 / $4,818.76
| Facility | | $1,688.00 | $2,988.75 | $4,818.76 |
- 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 |