- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $6,066.00 / $11,100.08
| Facility | | $4,277.00 | $6,066.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,639.13 / $2,684.17 / $5,140.57
| Professional | | $1,639.13 | $2,684.17 | $5,140.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,429.15 / $4,105.26 / $14,479.00
| Facility | | $2,429.15 | $4,105.26 | $14,479.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,093.52 / $3,911.18 / $5,074.43
| Facility | | $3,093.52 | $3,911.18 | $5,074.43 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |