- 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
- $103.49 / $160.55 / $485.68
| Professional | | $103.49 | $160.55 | $485.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.84 / $232.38 / $4,663.00
| Facility | | $133.84 | $232.38 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $200.17 / $276.55 / $1,552.02
| Facility | | $200.17 | $276.55 | $1,552.02 |
- 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 |