- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,166.29 / $5,909.48 / $13,841.56
| Facility | | $2,166.29 | $5,909.48 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $779.00 / $1,556.10 / $11,100.08
| Professional | | $779.00 | $1,556.10 | $11,100.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,551.47 / $4,813.14 / $9,035.51
| Facility | | $3,551.47 | $4,813.14 | $9,035.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $289.08 / $1,242.00 / $4,406.00
| Facility | | $289.08 | $1,242.00 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |