- 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
- $112.69 / $163.62 / $1,130.43
| Professional | | $112.69 | $163.62 | $1,130.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $285.08 / $574.94 / $1,966.00
| Facility | | $285.08 | $574.94 | $1,966.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $267.83 / $467.92 / $728.29
| Facility | | $267.83 | $467.92 | $728.29 |
- 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 |