- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,171.70 / $1,951.09 / $3,824.05
| Professional | | $1,171.70 | $1,951.09 | $3,824.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,965.78 / $2,856.98 / $10,463.00
| Facility | | $1,965.78 | $2,856.98 | $10,463.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,286.48 / $2,844.40 / $3,720.27
| Facility | | $2,286.48 | $2,844.40 | $3,720.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |