- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $8,042.03
| Facility | | $3,468.00 | $4,917.20 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $323.68 / $504.11 / $1,120.00
| Professional | | $323.68 | $504.11 | $1,120.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $566.62 / $10,352.00 / $47,480.61
| Facility | | $566.62 | $10,352.00 | $47,480.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $757.16 / $1,115.84 / $26,630.95
| Facility | | $757.16 | $1,115.84 | $26,630.95 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $10,398.00 / $15,622.00 / $26,415.00
| Facility | | $10,398.00 | $15,622.00 | $26,415.00 |