- 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
- $75.43 / $133.27 / $443.41
| Professional | | $75.43 | $133.27 | $443.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.00 / $200.00 / $2,000.00
| Facility | | $140.00 | $200.00 | $2,000.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.00 / $189.81 / $248.19
| Facility | | $140.00 | $189.81 | $248.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,623.00 / $2,126.00
| Facility | | $1,026.00 | $1,623.00 | $2,126.00 |