- 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
- $182.63 / $307.31 / $631.99
| Professional | | $182.63 | $307.31 | $631.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.30 / $463.85 / $5,301.00
| Facility | | $267.30 | $463.85 | $5,301.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $355.00 / $502.62 / $1,750.65
| Facility | | $355.00 | $502.62 | $1,750.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |