- 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
- $921.51 / $1,594.34 / $2,669.97
| Professional | | $921.51 | $1,594.34 | $2,669.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,806.63 / $2,633.37 / $11,051.00
| Facility | | $1,806.63 | $2,633.37 | $11,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,507.86 / $2,250.71 / $2,962.12
| Facility | | $1,507.86 | $2,250.71 | $2,962.12 |
- 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 |