- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $458.27 / $5,091.00 / $7,407.54
| Facility | | $458.27 | $5,091.00 | $7,407.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $147.33 / $263.33 / $487.98
| Professional | | $147.33 | $263.33 | $487.98 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $345.05 / $630.71 / $20,604.33
| Facility | | $345.05 | $630.71 | $20,604.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $309.00 / $477.88 / $10,523.43
| Facility | | $309.00 | $477.88 | $10,523.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |