- 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
- $87.56 / $340.02 / $758.72
| Professional | | $87.56 | $340.02 | $758.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $137.41 / $415.46 / $1,712.24
| Facility | | $137.41 | $415.46 | $1,712.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $205.77 / $560.41 / $743.66
| Facility | | $205.77 | $560.41 | $743.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |