- 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
- $120.36 / $180.54 / $501.74
| Professional | | $120.36 | $180.54 | $501.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $148.85 / $228.33 / $1,623.00
| Facility | | $148.85 | $228.33 | $1,623.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $204.50 / $258.25 / $381.69
| Facility | | $204.50 | $258.25 | $381.69 |
- 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 |