- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,100.08 / $20,928.72
| Facility | | $5,463.36 | $11,100.08 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $1,556.10 / $12,765.09
| Professional | | $1,161.00 | $1,556.10 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,859.66 / $2,445.96 / $4,731.27
| Facility | | $1,859.66 | $2,445.96 | $4,731.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $769.64 / $1,775.00 / $6,169.00
| Facility | | $769.64 | $1,775.00 | $6,169.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,775.00 / $3,227.00 / $6,169.00
| Facility | | $1,775.00 | $3,227.00 | $6,169.00 |