- 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
- $827.46 / $1,419.55 / $2,378.01
| Professional | | $827.46 | $1,419.55 | $2,378.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.70 / $2,367.71 / $11,051.00
| Facility | | $1,609.70 | $2,367.71 | $11,051.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,343.29 / $2,004.24 / $2,645.79
| Facility | | $1,343.29 | $2,004.24 | $2,645.79 |
- 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 |