- 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
- $223.38 / $404.76 / $727.33
| Professional | | $223.38 | $404.76 | $727.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $718.56 / $9,495.24
| Facility | | $452.00 | $718.56 | $9,495.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $452.00 / $755.01 / $3,018.60
| Facility | | $452.00 | $755.01 | $3,018.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |