- 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
- $98.01 / $168.29 / $362.80
| Professional | | $98.01 | $168.29 | $362.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.63 / $245.16 / $993.47
| Facility | | $156.63 | $245.16 | $993.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $212.09 / $281.85 / $381.10
| Facility | | $212.09 | $281.85 | $381.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $523.94 / $1,047.17 / $1,966.00
| Facility | | $523.94 | $1,047.17 | $1,966.00 |