- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,960.00 / $11,611.47
| Facility | | $4,964.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $212.18 / $1,337.06 / $3,064.68
| Professional | | $212.18 | $1,337.06 | $3,064.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $493.70 / $2,194.94 / $10,320.00
| Facility | | $493.70 | $2,194.94 | $10,320.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $508.86 / $2,248.00 / $4,164.35
| Facility | | $508.86 | $2,248.00 | $4,164.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |