- 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
- $728.18 / $1,111.78 / $2,065.36
| Professional | | $728.18 | $1,111.78 | $2,065.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,057.05 / $2,054.48 / $12,000.00
| Facility | | $1,057.05 | $2,054.48 | $12,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,296.00 / $2,285.98 / $5,193.96
| Facility | | $1,296.00 | $2,285.98 | $5,193.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,036.00 / $8,847.00 / $13,055.54
| Facility | | $6,036.00 | $8,847.00 | $13,055.54 |