- 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
- $687.98 / $972.41 / $2,009.52
| Professional | | $687.98 | $972.41 | $2,009.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,219.25 / $2,124.76 / $6,945.09
| Facility | | $1,219.25 | $2,124.76 | $6,945.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,411.69 / $1,901.49 / $2,428.62
| Facility | | $1,411.69 | $1,901.49 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |