- 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
- $132.59 / $275.20 / $481.61
| Professional | | $132.59 | $275.20 | $481.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.48 / $629.09 / $6,306.00
| Facility | | $303.48 | $629.09 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $327.76 / $659.23 / $1,908.09
| Facility | | $327.76 | $659.23 | $1,908.09 |
- 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 |