- 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
- $801.38 / $1,320.08 / $2,174.06
| Professional | | $801.38 | $1,320.08 | $2,174.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.33 / $2,438.36 / $14,396.24
| Facility | | $1,219.33 | $2,438.36 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,430.00 / $2,613.19 / $5,383.60
| Facility | | $1,430.00 | $2,613.19 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |