- 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
- $533.89 / $936.36 / $1,745.47
| Professional | | $533.89 | $936.36 | $1,745.47 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $865.51 / $1,475.91 / $27,598.19
| Facility | | $865.51 | $1,475.91 | $27,598.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $845.32 / $1,260.91 / $1,649.19
| Facility | | $845.32 | $1,260.91 | $1,649.19 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,542.00 / $12,871.00 / $16,293.00
| Facility | | $9,542.00 | $12,871.00 | $16,293.00 |