- 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
- $442.85 / $722.12 / $1,268.83
| Professional | | $442.85 | $722.12 | $1,268.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $484.88 / $1,040.02 / $1,346.44
| Facility | | $484.88 | $1,040.02 | $1,346.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.58 / $1,040.02 / $1,341.77
| Facility | | $207.58 | $1,040.02 | $1,341.77 |
- 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 |