- 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
- $480.51 / $796.45 / $1,533.07
| Professional | | $480.51 | $796.45 | $1,533.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $988.19 / $1,630.31 / $6,306.00
| Facility | | $988.19 | $1,630.31 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,133.94 / $1,598.00 / $2,308.21
| Facility | | $1,133.94 | $1,598.00 | $2,308.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |