- 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
- $436.87 / $686.81 / $1,787.37
| Professional | | $436.87 | $686.81 | $1,787.37 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $544.88 / $1,005.15 / $6,608.00
| Facility | | $544.88 | $1,005.15 | $6,608.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $742.35 / $1,005.15 / $1,415.13
| Facility | | $742.35 | $1,005.15 | $1,415.13 |
- 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 |