- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,778.89 / $7,119.04
| Facility | | $2,906.00 | $4,778.89 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $171.34 / $258.06 / $608.76
| Professional | | $171.34 | $258.06 | $608.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $224.05 / $443.14 / $6,527.97
| Facility | | $224.05 | $443.14 | $6,527.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.26 / $556.48 / $3,508.23
| Facility | | $341.26 | $556.48 | $3,508.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |