- 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
- $369.57 / $607.50 / $1,038.90
| Professional | | $369.57 | $607.50 | $1,038.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.28 / $1,074.43 / $27,970.06
| Facility | | $544.28 | $1,074.43 | $27,970.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $696.05 / $1,120.51 / $21,010.16
| Facility | | $696.05 | $1,120.51 | $21,010.16 |
- 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 |