- 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
- $842.49 / $1,421.14 / $1,761.56
| Professional | | $842.49 | $1,421.14 | $1,761.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,572.34 / $2,468.11 / $13,882.69
| Facility | | $1,572.34 | $2,468.11 | $13,882.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,391.34 / $2,069.58 / $2,664.50
| Facility | | $1,391.34 | $2,069.58 | $2,664.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |