- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $514.51 / $4,014.00 / $11,821.00
| Facility | | $514.51 | $4,014.00 | $11,821.00 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $187.72 / $292.89 / $727.89
| Professional | | $187.72 | $292.89 | $727.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $270.80 / $513.34 / $2,126.00
| Facility | | $270.80 | $513.34 | $2,126.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $303.80 / $426.44 / $527.99
| Facility | | $303.80 | $426.44 | $527.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |