- 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
- $279.52 / $444.48 / $1,012.48
| Professional | | $279.52 | $444.48 | $1,012.48 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $364.30 / $693.27 / $1,914.00
| Facility | | $364.30 | $693.27 | $1,914.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $547.08 / $688.36 / $913.52
| Facility | | $547.08 | $688.36 | $913.52 |
- 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 |