- 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
- $138.26 / $197.78 / $544.00
| Professional | | $138.26 | $197.78 | $544.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $158.76 / $312.91 / $1,914.00
| Facility | | $158.76 | $312.91 | $1,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $209.32 / $305.77 / $406.70
| Facility | | $209.32 | $305.77 | $406.70 |
- 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 |