- 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
- $181.51 / $303.42 / $596.30
| Professional | | $181.51 | $303.42 | $596.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.04 / $478.41 / $1,607.00
| Facility | | $247.04 | $478.41 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $321.58 / $425.77 / $516.67
| Facility | | $321.58 | $425.77 | $516.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |