- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $237.22 / $710.38 / $1,380.23
| Professional | | $237.22 | $710.38 | $1,380.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $416.21 / $844.00 / $3,825.00
| Facility | | $416.21 | $844.00 | $3,825.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $495.73 / $924.33 / $1,484.78
| Facility | | $495.73 | $924.33 | $1,484.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,044.00 / $4,663.00 / $7,305.00
| Facility | | $3,044.00 | $4,663.00 | $7,305.00 |