- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,603.25 / $5,091.00 / $12,765.09
| Facility | | $1,603.25 | $5,091.00 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $536.65 / $818.28 / $2,023.68
| Professional | | $536.65 | $818.28 | $2,023.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $910.97 / $1,652.40 / $82,339.17
| Facility | | $910.97 | $1,652.40 | $82,339.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,114.70 / $1,739.44 / $50,896.80
| Facility | | $1,114.70 | $1,739.44 | $50,896.80 |
- 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 |