- 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
- $69.81 / $224.57 / $433.65
| Professional | | $69.81 | $224.57 | $433.65 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $150.66 / $294.41 / $557.82
| Facility | | $150.66 | $294.41 | $557.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $163.04 / $251.33 / $482.96
| Facility | | $163.04 | $251.33 | $482.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,623.00 / $2,126.00
| Facility | | $1,026.00 | $1,623.00 | $2,126.00 |