- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,218.00 / $3,576.15 / $7,119.04
| Facility | | $2,218.00 | $3,576.15 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $93.28 / $134.57 / $336.83
| Professional | | $93.28 | $134.57 | $336.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $153.05 / $303.27 / $7,104.12
| Facility | | $153.05 | $303.27 | $7,104.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.48 / $334.81 / $2,052.00
| Facility | | $191.48 | $334.81 | $2,052.00 |
- 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 |