- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,833.00 / $3,666.78 / $7,119.04
| Facility | | $2,833.00 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $186.17 / $472.89 / $741.93
| Professional | | $186.17 | $472.89 | $741.93 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $448.65 / $712.03 / $5,582.51
| Facility | | $448.65 | $712.03 | $5,582.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $424.93 / $699.53 / $1,813.25
| Facility | | $424.93 | $699.53 | $1,813.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |