- 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
- $773.60 / $1,340.97 / $2,726.57
| Professional | | $773.60 | $1,340.97 | $2,726.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,243.68 / $2,225.44 / $14,525.55
| Facility | | $1,243.68 | $2,225.44 | $14,525.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,436.00 / $2,538.28 / $7,146.52
| Facility | | $1,436.00 | $2,538.28 | $7,146.52 |
- 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 |