- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $4,964.00 / $9,185.68
| Facility | | $4,146.00 | $4,964.00 | $9,185.68 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $157.13 / $229.15 / $1,987.83
| Professional | | $157.13 | $229.15 | $1,987.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.81 / $615.53 / $1,966.00
| Facility | | $374.81 | $615.53 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $374.81 / $567.65 / $782.48
| Facility | | $374.81 | $567.65 | $782.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,623.00 / $2,126.00
| Facility | | $1,204.00 | $1,623.00 | $2,126.00 |