- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,549.00 / $11,100.08
| Facility | | $4,277.00 | $5,549.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $326.87 / $507.78 / $1,198.08
| Professional | | $326.87 | $507.78 | $1,198.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $422.19 / $860.73 / $6,608.00
| Facility | | $422.19 | $860.73 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $516.46 / $773.88 / $1,005.35
| Facility | | $516.46 | $773.88 | $1,005.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,847.00 / $7,305.00
| Facility | | $2,126.00 | $5,847.00 | $7,305.00 |