- 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
- $98.37 / $160.58 / $487.16
| Professional | | $98.37 | $160.58 | $487.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $133.46 / $228.73 / $4,663.00
| Facility | | $133.46 | $228.73 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.71 / $263.97 / $1,552.02
| Facility | | $195.71 | $263.97 | $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 |