- 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
- $148.13 / $282.41 / $475.60
| Professional | | $148.13 | $282.41 | $475.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $301.81 / $455.56 / $8,972.49
| Facility | | $301.81 | $455.56 | $8,972.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $286.00 / $482.87 / $3,054.91
| Facility | | $286.00 | $482.87 | $3,054.91 |
- 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 |