- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $939.43 / $1,212.72 / $5,090.02
| Facility | | $939.43 | $1,212.72 | $5,090.02 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $854.03 / $854.03 / $854.03
| Professional | | $854.03 | $854.03 | $854.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $70.20 / $258.20 / $422.33
| Facility | | $70.20 | $258.20 | $422.33 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $177.35 / $236.47 / $295.58
| Professional | | $177.35 | $236.47 | $295.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $252.16 / $252.16 / $252.16
| Facility | | $252.16 | $252.16 | $252.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $854.03 / $939.43 / $1,807.09
| Facility | | $854.03 | $939.43 | $1,807.09 |