- 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
- $858.63 / $1,457.16 / $2,523.03
| Professional | | $858.63 | $1,457.16 | $2,523.03 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,565.58 / $2,580.07 / $12,371.41
| Facility | | $1,565.58 | $2,580.07 | $12,371.41 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,602.00 / $2,828.16 / $4,818.76
| Facility | | $1,602.00 | $2,828.16 | $4,818.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,898.00 / $7,366.40 / $13,055.54
| Facility | | $4,898.00 | $7,366.40 | $13,055.54 |