- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $12,765.09
| Facility | | $4,277.00 | $6,066.00 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $473.62 / $755.09 / $1,221.01
| Professional | | $473.62 | $755.09 | $1,221.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $784.61 / $1,410.93 / $7,984.00
| Facility | | $784.61 | $1,410.93 | $7,984.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $779.17 / $1,130.99 / $1,536.20
| Facility | | $779.17 | $1,130.99 | $1,536.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,522.00 / $5,454.00
| Facility | | $1,775.00 | $3,522.00 | $5,454.00 |