- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $849.79 / $1,446.75 / $2,729.81
| Professional | | $849.79 | $1,446.75 | $2,729.81 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,385.36 / $2,528.11 / $13,882.69
| Facility | | $1,385.36 | $2,528.11 | $13,882.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,424.55 / $2,112.05 / $2,748.84
| Facility | | $1,424.55 | $2,112.05 | $2,748.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |