- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $710.66 / $1,821.00 / $5,110.72
| Facility | | $710.66 | $1,821.00 | $5,110.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $480.00 / $562.05 / $657.00
| Professional | | $480.00 | $562.05 | $657.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $211.37 / $211.37 / $240.96
| Facility | | $211.37 | $211.37 | $240.96 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $116.28 / $541.00 / $561.00
| Facility | | $116.28 | $541.00 | $561.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $95.00 / $271.00 / $768.00
| Facility | | $95.00 | $271.00 | $768.00 |