- 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
- $976.71 / $1,381.36 / $2,436.94
| Professional | | $976.71 | $1,381.36 | $2,436.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.35 / $2,900.22 / $9,874.90
| Facility | | $1,321.35 | $2,900.22 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,531.00 / $2,454.03 / $3,174.08
| Facility | | $1,531.00 | $2,454.03 | $3,174.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |