- 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
- $273.20 / $430.64 / $711.61
| Professional | | $273.20 | $430.64 | $711.61 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $297.44 / $616.05 / $805.87
| Facility | | $297.44 | $616.05 | $805.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $207.58 / $641.55 / $805.87
| Facility | | $207.58 | $641.55 | $805.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $314.98 / $720.98 / $1,966.00
| Facility | | $314.98 | $720.98 | $1,966.00 |