- 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
- $893.34 / $1,486.21 / $2,483.23
| Professional | | $893.34 | $1,486.21 | $2,483.23 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,293.21 / $2,381.14 / $6,572.72
| Facility | | $1,293.21 | $2,381.14 | $6,572.72 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,457.21 / $2,113.52 / $2,877.21
| Facility | | $1,457.21 | $2,113.52 | $2,877.21 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,988.00 / $8,342.00
| Facility | | $3,711.00 | $5,988.00 | $8,342.00 |