- 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
- $87.55 / $286.30 / $783.12
| Professional | | $87.55 | $286.30 | $783.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $149.93 / $333.58 / $1,778.52
| Facility | | $149.93 | $333.58 | $1,778.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $187.36 / $464.85 / $707.92
| Facility | | $187.36 | $464.85 | $707.92 |
- 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 |