- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,100.08 / $20,928.72
| Facility | | $5,463.36 | $11,100.08 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $1,556.10 / $12,765.09
| Professional | | $1,161.00 | $1,556.10 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,231.10 / $1,606.29 / $3,132.14
| Facility | | $1,231.10 | $1,606.29 | $3,132.14 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $372.12 / $1,242.00 / $4,406.00
| Facility | | $372.12 | $1,242.00 | $4,406.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,031.00 / $1,775.00 / $4,406.00
| Facility | | $1,031.00 | $1,775.00 | $4,406.00 |