- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $193.05 / $1,437.68 / $1,952.16
| Professional | | $193.05 | $1,437.68 | $1,952.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $449.06 / $2,116.80 / $10,188.00
| Facility | | $449.06 | $2,116.80 | $10,188.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $480.78 / $2,784.24 / $4,321.97
| Facility | | $480.78 | $2,784.24 | $4,321.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |