- 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
- $145.26 / $332.73 / $725.16
| Professional | | $145.26 | $332.73 | $725.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $245.99 / $485.00 / $1,966.96
| Facility | | $245.99 | $485.00 | $1,966.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $264.24 / $477.82 / $743.15
| Facility | | $264.24 | $477.82 | $743.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,482.00 / $5,454.00
| Facility | | $1,775.00 | $3,482.00 | $5,454.00 |