- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $150.43 / $262.00 / $578.17
| Professional | | $150.43 | $262.00 | $578.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $218.15 / $371.40 / $1,321.00
| Facility | | $218.15 | $371.40 | $1,321.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $246.69 / $369.60 / $508.91
| Facility | | $246.69 | $369.60 | $508.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,026.00 / $1,607.00 / $1,966.00
| Facility | | $1,026.00 | $1,607.00 | $1,966.00 |