- 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
- $728.26 / $1,405.57 / $2,356.34
| Professional | | $728.26 | $1,405.57 | $2,356.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,187.41 / $1,985.57 / $6,306.00
| Facility | | $1,187.41 | $1,985.57 | $6,306.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.19 / $1,986.89 / $2,652.99
| Facility | | $1,336.19 | $1,986.89 | $2,652.99 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,732.00 / $8,342.00
| Facility | | $4,217.00 | $5,732.00 | $8,342.00 |