- 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
- $81.38 / $140.40 / $244.80
| Professional | | $81.38 | $140.40 | $244.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.82 / $202.92 / $5,847.00
| Facility | | $132.82 | $202.92 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $126.64 / $192.87 / $243.44
| Facility | | $126.64 | $192.87 | $243.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |