- 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
- $82.79 / $146.85 / $499.61
| Professional | | $82.79 | $146.85 | $499.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $129.01 / $211.09 / $1,607.00
| Facility | | $129.01 | $211.09 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $195.05 / $254.72 / $364.98
| Facility | | $195.05 | $254.72 | $364.98 |
- 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 |