- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,496.00 / $4,964.00 / $7,119.04
| Facility | | $3,496.00 | $4,964.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $148.91 / $393.26 / $706.76
| Professional | | $148.91 | $393.26 | $706.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $256.35 / $474.82 / $4,910.83
| Facility | | $256.35 | $474.82 | $4,910.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.61 / $657.92 / $2,197.38
| Facility | | $340.61 | $657.92 | $2,197.38 |
- 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 |