- 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
- $1,072.49 / $1,808.66 / $2,882.63
| Professional | | $1,072.49 | $1,808.66 | $2,882.63 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,450.79 / $3,058.25 / $12,871.00
| Facility | | $1,450.79 | $3,058.25 | $12,871.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,814.19 / $2,541.46 / $3,612.92
| Facility | | $1,814.19 | $2,541.46 | $3,612.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $13,657.65 / $16,616.96
| Facility | | $9,542.00 | $13,657.65 | $16,616.96 |