- 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
- $123.48 / $344.33 / $645.92
| Professional | | $123.48 | $344.33 | $645.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $184.20 / $440.00 / $5,023.00
| Facility | | $184.20 | $440.00 | $5,023.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $283.58 / $636.28 / $1,913.58
| Facility | | $283.58 | $636.28 | $1,913.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |