- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,725.14 / $5,091.00 / $10,506.16
| Facility | | $2,725.14 | $5,091.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $836.26 / $1,496.29 / $2,481.17
| Professional | | $836.26 | $1,496.29 | $2,481.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,650.54 / $2,591.13 / $14,396.24
| Facility | | $1,650.54 | $2,591.13 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,537.00 / $2,754.34 / $5,383.60
| Facility | | $1,537.00 | $2,754.34 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,354.00 / $8,868.00 / $11,869.99
| Facility | | $6,354.00 | $8,868.00 | $11,869.99 |