- 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
- $573.40 / $810.70 / $1,511.40
| Professional | | $573.40 | $810.70 | $1,511.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,044.27 / $1,783.43 / $6,945.09
| Facility | | $1,044.27 | $1,783.43 | $6,945.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,200.49 / $1,700.60 / $2,428.62
| Facility | | $1,200.49 | $1,700.60 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $5,327.00 / $8,342.00
| Facility | | $4,217.00 | $5,327.00 | $8,342.00 |