- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $558.57 / $862.81 / $2,622.99
| Professional | | $558.57 | $862.81 | $2,622.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $825.82 / $1,472.09 / $50,039.36
| Facility | | $825.82 | $1,472.09 | $50,039.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,299.76 / $1,633.51 / $53,625.80
| Facility | | $1,299.76 | $1,633.51 | $53,625.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $16,167.00 / $18,245.00 / $44,635.00
| Facility | | $16,167.00 | $18,245.00 | $44,635.00 |