- 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
- $62.17 / $125.05 / $309.94
| Professional | | $62.17 | $125.05 | $309.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $115.67 / $201.35 / $2,033.70
| Facility | | $115.67 | $201.35 | $2,033.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $122.00 / $185.90 / $271.61
| Facility | | $122.00 | $185.90 | $271.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |