- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,011.73 / $4,964.00 / $8,042.03
| Facility | | $1,011.73 | $4,964.00 | $8,042.03 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $321.86 / $501.55 / $989.44
| Professional | | $321.86 | $501.55 | $989.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $563.73 / $10,352.00 / $26,876.61
| Facility | | $563.73 | $10,352.00 | $26,876.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.00 / $1,098.08 / $15,063.60
| Facility | | $742.00 | $1,098.08 | $15,063.60 |
- 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 |