- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $3,795.64 / $10,072.31
| Facility | | $2,293.00 | $3,795.64 | $10,072.31 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $238.59 / $471.84 / $643.66
| Professional | | $238.59 | $471.84 | $643.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $387.66 / $628.02 / $3,044.00
| Facility | | $387.66 | $628.02 | $3,044.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $431.69 / $588.86 / $1,038.94
| Facility | | $431.69 | $588.86 | $1,038.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $4,663.00 / $7,305.00
| Facility | | $1,770.00 | $4,663.00 | $7,305.00 |