- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,795.64 / $7,119.04
| Facility | | $2,218.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.59 / $432.15 / $916.56
| Professional | | $212.59 | $432.15 | $916.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.84 / $546.29 / $6,558.00
| Facility | | $204.84 | $546.29 | $6,558.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $339.88 / $648.20 / $3,988.97
| Facility | | $339.88 | $648.20 | $3,988.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $7,405.00 / $9,874.90
| Facility | | $4,700.00 | $7,405.00 | $9,874.90 |