- 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
- $181.37 / $271.67 / $665.74
| Professional | | $181.37 | $271.67 | $665.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $244.39 / $469.38 / $4,871.77
| Facility | | $244.39 | $469.38 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.40 / $592.74 / $1,622.05
| Facility | | $362.40 | $592.74 | $1,622.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,490.77 / $4,663.00 / $6,267.00
| Facility | | $2,490.77 | $4,663.00 | $6,267.00 |