- 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
- $131.56 / $217.28 / $262.18
| Professional | | $131.56 | $217.28 | $262.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.94 / $327.42 / $1,341.00
| Facility | | $211.94 | $327.42 | $1,341.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $242.38 / $311.49 / $402.90
| Facility | | $242.38 | $311.49 | $402.90 |
- 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 |