- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,066.00 / $7,119.04
| Facility | | $4,964.00 | $6,066.00 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $242.15 / $419.06 / $1,050.74
| Professional | | $242.15 | $419.06 | $1,050.74 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $340.07 / $580.88 / $1,387.83
| Facility | | $340.07 | $580.88 | $1,387.83 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $392.33 / $591.05 / $805.07
| Facility | | $392.33 | $591.05 | $805.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |