- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,405.00 / $10,255.42
| Facility | | $5,012.00 | $6,405.00 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $911.29 / $1,425.87 / $3,431.58
| Professional | | $911.29 | $1,425.87 | $3,431.58 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,264.66 / $2,101.31 / $4,663.00
| Facility | | $1,264.66 | $2,101.31 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,472.40 / $2,157.91 / $2,894.20
| Facility | | $1,472.40 | $2,157.91 | $2,894.20 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |