- 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
- $257.27 / $476.30 / $783.04
| Professional | | $257.27 | $476.30 | $783.04 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $540.25 / $782.71 / $8,586.74
| Facility | | $540.25 | $782.71 | $8,586.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.00 / $844.70 / $3,170.91
| Facility | | $495.00 | $844.70 | $3,170.91 |
- 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 |