- 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
- $307.13 / $427.43 / $595.11
| Professional | | $307.13 | $427.43 | $595.11 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $247.08 / $518.47 / $1,607.00
| Facility | | $247.08 | $518.47 | $1,607.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $199.85 / $322.00 / $885.14
| Facility | | $199.85 | $322.00 | $885.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |