- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $5,091.00 / $9,248.33
| Facility | | $3,496.00 | $5,091.00 | $9,248.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $365.67 / $570.02 / $1,294.08
| Professional | | $365.67 | $570.02 | $1,294.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $633.98 / $16,167.00 / $82,339.17
| Facility | | $633.98 | $16,167.00 | $82,339.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $822.40 / $1,251.38 / $50,308.66
| Facility | | $822.40 | $1,251.38 | $50,308.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,237.00 / $25,438.00 / $65,894.00
| Facility | | $16,237.00 | $25,438.00 | $65,894.00 |