- 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
- $45.37 / $326.23 / $574.49
| Professional | | $45.37 | $326.23 | $574.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $55.00 / $493.94 / $1,640.00
| Facility | | $55.00 | $493.94 | $1,640.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $101.68 / $621.54 / $966.84
| Facility | | $101.68 | $621.54 | $966.84 |
- 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 |