- 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
- $166.86 / $466.46 / $817.32
| Professional | | $166.86 | $466.46 | $817.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $440.96 / $860.03 / $4,146.27
| Facility | | $440.96 | $860.03 | $4,146.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $419.91 / $909.04 / $1,207.40
| Facility | | $419.91 | $909.04 | $1,207.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |