- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $2,763.20 / $4,420.74 / $8,739.50
| Professional | | $2,763.20 | $4,420.74 | $8,739.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,084.48 / $6,616.19 / $14,242.22
| Facility | | $4,084.48 | $6,616.19 | $14,242.22 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,957.00 / $6,466.51 / $8,250.46
| Facility | | $4,957.00 | $6,466.51 | $8,250.46 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |