- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,530.35 / $6,066.00 / $11,100.08
| Facility | | $1,530.35 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $451.25 / $858.52 / $2,968.99
| Professional | | $451.25 | $858.52 | $2,968.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,223.91 / $2,790.50 / $28,859.40
| Facility | | $1,223.91 | $2,790.50 | $28,859.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,143.24 / $2,432.87 / $19,539.43
| Facility | | $1,143.24 | $2,432.87 | $19,539.43 |
- 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 |