- 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
- $102.51 / $298.35 / $566.39
| Professional | | $102.51 | $298.35 | $566.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.96 / $413.03 / $1,277.32
| Facility | | $250.96 | $413.03 | $1,277.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $250.96 / $349.49 / $582.48
| Facility | | $250.96 | $349.49 | $582.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |