- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $81.20 / $426.47 / $1,369.45
| Professional | | $81.20 | $426.47 | $1,369.45 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $127.87 / $375.65 / $855.60
| Facility | | $127.87 | $375.65 | $855.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $147.22 / $400.40 / $849.10
| Facility | | $147.22 | $400.40 | $849.10 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,640.00 / $2,126.00
| Facility | | $1,204.00 | $1,640.00 | $2,126.00 |