- 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
- $805.29 / $1,215.03 / $2,872.78
| Professional | | $805.29 | $1,215.03 | $2,872.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,058.58 / $2,284.67 / $16,586.06
| Facility | | $1,058.58 | $2,284.67 | $16,586.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,108.00 / $2,553.92 / $6,156.40
| Facility | | $1,108.00 | $2,553.92 | $6,156.40 |
- 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 |