- 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
- $92.57 / $280.82 / $475.35
| Professional | | $92.57 | $280.82 | $475.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.44 / $342.00 / $3,416.04
| Facility | | $163.44 | $342.00 | $3,416.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.05 / $467.24 / $1,311.70
| Facility | | $211.05 | $467.24 | $1,311.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |