- 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
- $63.47 / $91.79 / $237.66
| Professional | | $63.47 | $91.79 | $237.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $90.82 / $189.12 / $5,244.00
| Facility | | $90.82 | $189.12 | $5,244.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $124.14 / $209.67 / $1,476.40
| Facility | | $124.14 | $209.67 | $1,476.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $5,023.00 / $7,305.00
| Facility | | $3,044.00 | $5,023.00 | $7,305.00 |