- 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
- $59.58 / $250.85 / $541.74
| Professional | | $59.58 | $250.85 | $541.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $155.05 / $499.82 / $4,146.27
| Facility | | $155.05 | $499.82 | $4,146.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $156.35 / $509.22 / $1,207.40
| Facility | | $156.35 | $509.22 | $1,207.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,611.00 / $3,902.18 / $5,454.00
| Facility | | $1,611.00 | $3,902.18 | $5,454.00 |