- 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
- $150.00 / $242.62 / $403.72
| Professional | | $150.00 | $242.62 | $403.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $213.29 / $448.32 / $8,342.00
| Facility | | $213.29 | $448.32 | $8,342.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $265.00 / $494.67 / $3,093.19
| Facility | | $265.00 | $494.67 | $3,093.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,097.02 / $6,608.00 / $8,664.71
| Facility | | $4,097.02 | $6,608.00 | $8,664.71 |