- 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
- $145.79 / $218.69 / $607.37
| Professional | | $145.79 | $218.69 | $607.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $180.47 / $278.04 / $1,623.00
| Facility | | $180.47 | $278.04 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.52 / $313.92 / $466.15
| Facility | | $247.52 | $313.92 | $466.15 |
- 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 |