- 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
- $952.02 / $1,620.05 / $2,760.76
| Professional | | $952.02 | $1,620.05 | $2,760.76 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,444.60 / $2,890.78 / $14,396.24
| Facility | | $1,444.60 | $2,890.78 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,726.00 / $3,097.78 / $5,383.60
| Facility | | $1,726.00 | $3,097.78 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |