- 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
- $138.66 / $208.00 / $583.74
| Professional | | $138.66 | $208.00 | $583.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $173.25 / $266.83 / $1,623.00
| Facility | | $173.25 | $266.83 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $237.71 / $301.31 / $441.11
| Facility | | $237.71 | $301.31 | $441.11 |
- 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 |