- 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
- $1,090.10 / $1,902.74 / $3,273.50
| Professional | | $1,090.10 | $1,902.74 | $3,273.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,082.19 / $3,369.72 / $14,396.24
| Facility | | $2,082.19 | $3,369.72 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,022.00 / $3,590.84 / $5,383.60
| Facility | | $2,022.00 | $3,590.84 | $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 |