- 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
- $94.38 / $169.46 / $349.33
| Professional | | $94.38 | $169.46 | $349.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.29 / $227.82 / $1,607.00
| Facility | | $132.29 | $227.82 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.00 / $249.64 / $349.36
| Facility | | $212.00 | $249.64 | $349.36 |
- 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 |