- 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
- $676.09 / $1,020.16 / $2,898.88
| Professional | | $676.09 | $1,020.16 | $2,898.88 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,076.21 / $1,967.23 / $23,351.66
| Facility | | $1,076.21 | $1,967.23 | $23,351.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,351.03 / $2,154.15 / $8,854.25
| Facility | | $1,351.03 | $2,154.15 | $8,854.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |