- 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
- $846.19 / $1,204.45 / $2,513.50
| Professional | | $846.19 | $1,204.45 | $2,513.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,353.87 / $2,380.98 / $7,104.12
| Facility | | $1,353.87 | $2,380.98 | $7,104.12 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,360.00 / $1,854.85 / $2,472.66
| Facility | | $1,360.00 | $1,854.85 | $2,472.66 |
- 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 |