- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $595.46 / $1,006.34 / $1,924.04
| Professional | | $595.46 | $1,006.34 | $1,924.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,000.57 / $1,705.41 / $13,476.00
| Facility | | $1,000.57 | $1,705.41 | $13,476.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,109.00 / $1,964.70 / $4,818.76
| Facility | | $1,109.00 | $1,964.70 | $4,818.76 |
- 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 |