- 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
- $55.30 / $112.14 / $220.61
| Professional | | $55.30 | $112.14 | $220.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $102.85 / $181.11 / $2,033.70
| Facility | | $102.85 | $181.11 | $2,033.70 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $109.00 / $165.28 / $242.63
| Facility | | $109.00 | $165.28 | $242.63 |
- 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 |