- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $3,666.78 / $7,119.04
| Facility | | $2,906.00 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $241.17 / $484.47 / $838.93
| Professional | | $241.17 | $484.47 | $838.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $389.02 / $701.27 / $7,123.00
| Facility | | $389.02 | $701.27 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $572.86 / $953.00 / $2,256.42
| Facility | | $572.86 | $953.00 | $2,256.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |