- 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
- $173.91 / $264.17 / $694.93
| Professional | | $173.91 | $264.17 | $694.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.70 / $448.65 / $10,214.08
| Facility | | $237.70 | $448.65 | $10,214.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $341.45 / $569.09 / $7,486.83
| Facility | | $341.45 | $569.09 | $7,486.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $6,588.00 / $10,320.00
| Facility | | $1,770.00 | $6,588.00 | $10,320.00 |