- 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
- $101.41 / $152.11 / $421.13
| Professional | | $101.41 | $152.11 | $421.13 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.66 / $190.71 / $1,623.00
| Facility | | $124.66 | $190.71 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $170.99 / $215.96 / $321.20
| Facility | | $170.99 | $215.96 | $321.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,775.00 / $3,560.25
| Facility | | $1,151.00 | $1,775.00 | $3,560.25 |