- 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
- $338.79 / $534.59 / $964.37
| Professional | | $338.79 | $534.59 | $964.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $603.37 / $974.01 / $10,061.00
| Facility | | $603.37 | $974.01 | $10,061.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $608.00 / $1,110.00 / $3,170.91
| Facility | | $608.00 | $1,110.00 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |