- 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
- $952.44 / $1,509.80 / $3,336.21
| Professional | | $952.44 | $1,509.80 | $3,336.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,305.58 / $2,356.69 / $48,984.50
| Facility | | $1,305.58 | $2,356.69 | $48,984.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,596.38 / $2,249.62 / $3,137.89
| Facility | | $1,596.38 | $2,249.62 | $3,137.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,204.00 / $1,607.00 / $2,126.00
| Facility | | $1,204.00 | $1,607.00 | $2,126.00 |