- 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
- $622.85 / $1,001.05 / $2,298.67
| Professional | | $622.85 | $1,001.05 | $2,298.67 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $970.20 / $1,569.50 / $10,398.00
| Facility | | $970.20 | $1,569.50 | $10,398.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,194.55 / $1,526.42 / $1,984.43
| Facility | | $1,194.55 | $1,526.42 | $1,984.43 |
- 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 |