- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,468.00 / $4,917.20 / $9,248.33
| Facility | | $3,468.00 | $4,917.20 | $9,248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $337.45 / $524.98 / $1,035.52
| Professional | | $337.45 | $524.98 | $1,035.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $586.94 / $10,352.00 / $47,480.61
| Facility | | $586.94 | $10,352.00 | $47,480.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.31 / $1,159.64 / $26,444.90
| Facility | | $784.31 | $1,159.64 | $26,444.90 |
- 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 |