- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,676.82 / $7,119.04
| Facility | | $2,906.00 | $4,676.82 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $272.74 / $519.38 / $800.64
| Professional | | $272.74 | $519.38 | $800.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $258.62 / $537.60 / $31,332.63
| Facility | | $258.62 | $537.60 | $31,332.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.76 / $768.08 / $37,029.47
| Facility | | $422.76 | $768.08 | $37,029.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $12,855.00 / $16,742.00 / $40,166.00
| Facility | | $12,855.00 | $16,742.00 | $40,166.00 |