- 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
- $471.88 / $810.14 / $1,350.63
| Professional | | $471.88 | $810.14 | $1,350.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $736.08 / $1,337.33 / $8,393.34
| Facility | | $736.08 | $1,337.33 | $8,393.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $863.00 / $1,549.87 / $3,170.91
| Facility | | $863.00 | $1,549.87 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |