- 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
- $934.69 / $1,577.49 / $1,958.55
| Professional | | $934.69 | $1,577.49 | $1,958.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,707.40 / $2,710.18 / $13,882.69
| Facility | | $1,707.40 | $2,710.18 | $13,882.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,538.72 / $2,274.33 / $2,948.54
| Facility | | $1,538.72 | $2,274.33 | $2,948.54 |
- 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 |