- 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
- $80.11 / $115.58 / $283.24
| Professional | | $80.11 | $115.58 | $283.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $132.82 / $217.96 / $1,914.00
| Facility | | $132.82 | $217.96 | $1,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $140.18 / $199.18 / $265.94
| Facility | | $140.18 | $199.18 | $265.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,151.00 / $1,775.00 / $3,560.25
| Facility | | $1,151.00 | $1,775.00 | $3,560.25 |