- 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
- $81.64 / $122.46 / $354.41
| Professional | | $81.64 | $122.46 | $354.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $104.26 / $160.18 / $1,623.00
| Facility | | $104.26 | $160.18 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $142.13 / $181.07 / $261.75
| Facility | | $142.13 | $181.07 | $261.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |