- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $31.09 / $52.71 / $109.74
| Professional | | $31.09 | $52.71 | $109.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $59.66 / $93.72 / $21,923.00
| Facility | | $59.66 | $93.72 | $21,923.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $50.88 / $76.41 / $98.36
| Facility | | $50.88 | $76.41 | $98.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,855.00 / $16,742.00 / $21,923.00
| Facility | | $12,855.00 | $16,742.00 | $21,923.00 |