- 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
- $405.03 / $629.33 / $1,502.72
| Professional | | $405.03 | $629.33 | $1,502.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $526.25 / $1,069.58 / $6,608.00
| Facility | | $526.25 | $1,069.58 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $641.41 / $960.71 / $1,249.52
| Facility | | $641.41 | $960.71 | $1,249.52 |
- 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 |