- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $3,666.78 / $7,119.04
| Facility | | $2,906.00 | $3,666.78 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $168.10 / $300.07 / $504.49
| Professional | | $168.10 | $300.07 | $504.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.02 / $502.49 / $8,342.00
| Facility | | $332.02 | $502.49 | $8,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $313.00 / $542.33 / $3,093.19
| Facility | | $313.00 | $542.33 | $3,093.19 |
- 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 |