- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $8,851.00 / $11,923.23
| Facility | | $4,964.00 | $8,851.00 | $11,923.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $745.28 / $1,253.64 / $2,481.17
| Professional | | $745.28 | $1,253.64 | $2,481.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,426.01 / $2,115.50 / $15,202.00
| Facility | | $1,426.01 | $2,115.50 | $15,202.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,314.29 / $1,954.47 / $2,458.98
| Facility | | $1,314.29 | $1,954.47 | $2,458.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |