- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $503.65 / $5,048.00 / $10,903.20
| Facility | | $503.65 | $5,048.00 | $10,903.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,525.00 / $11,065.00 / $12,418.00
| Facility | | $8,525.00 | $11,065.00 | $12,418.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,802.11 / $3,362.53 / $4,195.41
| Professional | | $2,802.11 | $3,362.53 | $4,195.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $456.45 / $3,007.57 / $5,702.65
| Facility | | $456.45 | $3,007.57 | $5,702.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.17 / $548.10 / $7,902.00
| Facility | | $314.17 | $548.10 | $7,902.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,367.00 / $13,296.00 / $26,537.00
| Facility | | $8,367.00 | $13,296.00 | $26,537.00 |