- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $12,765.09
| Facility | | $4,277.00 | $6,066.00 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,218.43 / $2,080.69 / $3,398.40
| Professional | | $1,218.43 | $2,080.69 | $3,398.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,971.84 / $3,154.36 / $9,874.90
| Facility | | $1,971.84 | $3,154.36 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,012.23 / $3,001.20 / $3,876.75
| Facility | | $2,012.23 | $3,001.20 | $3,876.75 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,700.00 / $7,805.64 / $10,320.00
| Facility | | $4,700.00 | $7,805.64 | $10,320.00 |