- 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
- $150.50 / $224.65 / $631.00
| Professional | | $150.50 | $224.65 | $631.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $191.69 / $391.52 / $8,857.49
| Facility | | $191.69 | $391.52 | $8,857.49 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $280.70 / $461.92 / $3,170.91
| Facility | | $280.70 | $461.92 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |