- 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
- $59.18 / $101.04 / $183.64
| Professional | | $59.18 | $101.04 | $183.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.93 / $179.47 / $8,393.34
| Facility | | $115.93 | $179.47 | $8,393.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $114.00 / $192.92 / $3,170.91
| Facility | | $114.00 | $192.92 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |