- 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
- $932.75 / $1,580.02 / $3,024.87
| Professional | | $932.75 | $1,580.02 | $3,024.87 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,974.80 / $2,912.77 / $13,882.69
| Facility | | $1,974.80 | $2,912.77 | $13,882.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,534.61 / $2,291.92 / $2,947.93
| Facility | | $1,534.61 | $2,291.92 | $2,947.93 |
- 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 |