- 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
- $701.75 / $991.35 / $2,336.15
| Professional | | $701.75 | $991.35 | $2,336.15 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,251.90 / $2,187.69 / $6,173.85
| Facility | | $1,251.90 | $2,187.69 | $6,173.85 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,392.00 / $1,939.43 / $2,428.62
| Facility | | $1,392.00 | $1,939.43 | $2,428.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,938.87 / $4,808.59 / $6,854.80
| Facility | | $2,938.87 | $4,808.59 | $6,854.80 |