- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $10,563.53
| Facility | | $4,146.00 | $5,091.00 | $10,563.53 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $841.82 / $1,182.67 / $2,601.53
| Professional | | $841.82 | $1,182.67 | $2,601.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,216.69 / $2,513.30 / $9,874.90
| Facility | | $1,216.69 | $2,513.30 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,317.00 / $2,380.56 / $3,123.31
| Facility | | $1,317.00 | $2,380.56 | $3,123.31 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |