- 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
- $823.45 / $1,178.39 / $1,838.44
| Professional | | $823.45 | $1,178.39 | $1,838.44 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $973.57 / $2,147.19 / $13,960.05
| Facility | | $973.57 | $2,147.19 | $13,960.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,079.58 / $1,867.66 / $2,838.28
| Facility | | $1,079.58 | $1,867.66 | $2,838.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $6,110.41 / $8,342.00
| Facility | | $3,711.00 | $6,110.41 | $8,342.00 |