- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,545.00 / $5,463.36 / $13,841.56
| Facility | | $1,545.00 | $5,463.36 | $13,841.56 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $219.00 / $248.00 / $9,334.40
| Professional | | $219.00 | $248.00 | $9,334.40 |
- 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
- $191.70 / $343.78 / $4,317.00
| Facility | | $191.70 | $343.78 | $4,317.00 |