- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,098.00 / $11,100.08
| Facility | | $4,964.00 | $6,098.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $923.53 / $1,578.45 / $2,826.79
| Professional | | $923.53 | $1,578.45 | $2,826.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,874.13 / $2,800.94 / $13,882.69
| Facility | | $1,874.13 | $2,800.94 | $13,882.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,482.35 / $2,248.44 / $2,922.53
| Facility | | $1,482.35 | $2,248.44 | $2,922.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,965.59 / $11,397.14 / $14,242.22
| Facility | | $6,965.59 | $11,397.14 | $14,242.22 |