- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,698.24 / $3,801.89 / $12,302.69
| Facility | | $1,698.24 | $3,801.89 | $12,302.69 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $218.78 / $1,000.00 / $4,570.88
| Professional | | $218.78 | $1,000.00 | $4,570.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $4,677.35 / $8,912.51
| Facility | | $2,238.72 | $4,677.35 | $8,912.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $54.95 / $645.65 / $1,288.25
| Facility | | $54.95 | $645.65 | $1,288.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $181.97 / $707.95 / $1,412.54
| Facility | | $181.97 | $707.95 | $1,412.54 |