- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,234.00 / $3,795.64 / $7,119.04
| Facility | | $2,234.00 | $3,795.64 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $156.53 / $234.68 / $512.86
| Professional | | $156.53 | $234.68 | $512.86 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.56 / $389.72 / $4,871.77
| Facility | | $187.56 | $389.72 | $4,871.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $296.57 / $509.74 / $1,622.05
| Facility | | $296.57 | $509.74 | $1,622.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,444.39 / $4,645.00 / $7,305.00
| Facility | | $2,444.39 | $4,645.00 | $7,305.00 |