- 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
- $268.20 / $421.50 / $1,011.20
| Professional | | $268.20 | $421.50 | $1,011.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $350.31 / $706.83 / $6,608.00
| Facility | | $350.31 | $706.83 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $428.49 / $637.41 / $822.36
| Facility | | $428.49 | $637.41 | $822.36 |
- 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 |