- 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
- $1,180.52 / $2,058.04 / $3,680.94
| Professional | | $1,180.52 | $2,058.04 | $3,680.94 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,853.14 / $3,360.38 / $25,336.55
| Facility | | $1,853.14 | $3,360.38 | $25,336.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.00 / $3,879.33 / $8,854.25
| Facility | | $2,226.00 | $3,879.33 | $8,854.25 |
- 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 |