- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,421.00 / $4,917.20 / $7,119.04
| Facility | | $3,421.00 | $4,917.20 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $289.01 / $472.24 / $793.36
| Professional | | $289.01 | $472.24 | $793.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.07 / $831.04 / $8,342.00
| Facility | | $431.07 | $831.04 | $8,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $506.00 / $905.73 / $3,093.19
| Facility | | $506.00 | $905.73 | $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 |