- 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
- $335.78 / $522.50 / $1,167.35
| Professional | | $335.78 | $522.50 | $1,167.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $531.72 / $952.30 / $7,305.00
| Facility | | $531.72 | $952.30 | $7,305.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $610.46 / $866.46 / $1,104.36
| Facility | | $610.46 | $866.46 | $1,104.36 |
- 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 |