- 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
- $97.22 / $167.59 / $377.59
| Professional | | $97.22 | $167.59 | $377.59 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $177.54 / $345.81 / $5,454.00
| Facility | | $177.54 | $345.81 | $5,454.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $234.00 / $335.13 / $1,908.09
| Facility | | $234.00 | $335.13 | $1,908.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |