- 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
- $724.18 / $1,203.85 / $2,090.27
| Professional | | $724.18 | $1,203.85 | $2,090.27 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,217.80 / $2,071.73 / $9,388.90
| Facility | | $1,217.80 | $2,071.73 | $9,388.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,329.00 / $2,195.25 / $3,170.91
| Facility | | $1,329.00 | $2,195.25 | $3,170.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $7,091.00 / $10,320.00
| Facility | | $5,341.00 | $7,091.00 | $10,320.00 |