- 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
- $221.69 / $377.31 / $806.12
| Professional | | $221.69 | $377.31 | $806.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $332.76 / $549.40 / $4,853.58
| Facility | | $332.76 | $549.40 | $4,853.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $362.20 / $534.78 / $741.47
| Facility | | $362.20 | $534.78 | $741.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,770.00 / $7,487.00 / $11,732.00
| Facility | | $1,770.00 | $7,487.00 | $11,732.00 |