- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $95.22 / $163.08 / $467.41
| Professional | | $95.22 | $163.08 | $467.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $157.91 / $246.12 / $1,607.00
| Facility | | $157.91 | $246.12 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $183.53 / $235.82 / $312.86
| Facility | | $183.53 | $235.82 | $312.86 |
- 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 |