- 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
- $838.69 / $1,271.36 / $3,800.89
| Professional | | $838.69 | $1,271.36 | $3,800.89 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,315.63 / $2,446.42 / $23,351.66
| Facility | | $1,315.63 | $2,446.42 | $23,351.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,666.81 / $2,691.03 / $8,854.25
| Facility | | $1,666.81 | $2,691.03 | $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 |