- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,946.00 / $3,259.25 / $7,119.04
| Facility | | $1,946.00 | $3,259.25 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $33.45 / $187.05 / $239.63
| Professional | | $33.45 | $187.05 | $239.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $75.31 / $241.18 / $489.26
| Facility | | $75.31 | $241.18 | $489.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $77.87 / $235.00 / $367.20
| Facility | | $77.87 | $235.00 | $367.20 |
- 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 |