- 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
- $183.13 / $348.32 / $580.83
| Professional | | $183.13 | $348.32 | $580.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $369.37 / $552.17 / $5,244.00
| Facility | | $369.37 | $552.17 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.00 / $596.92 / $1,476.40
| Facility | | $350.00 | $596.92 | $1,476.40 |
- 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 |