- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,546.27 / $6,446.00 / $11,611.47
| Facility | | $1,546.27 | $6,446.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $573.16 / $896.23 / $1,877.04
| Professional | | $573.16 | $896.23 | $1,877.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,095.30 / $1,819.43 / $27,598.19
| Facility | | $1,095.30 | $1,819.43 | $27,598.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $920.65 / $1,323.64 / $1,581.39
| Facility | | $920.65 | $1,323.64 | $1,581.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,398.00 / $13,970.00 / $16,322.00
| Facility | | $10,398.00 | $13,970.00 | $16,322.00 |