- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $10,506.16
| Facility | | $4,693.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,087.33 / $2,292.23 / $4,654.57
| Professional | | $1,087.33 | $2,292.23 | $4,654.57 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,860.39 / $3,174.28 / $8,572.06
| Facility | | $1,860.39 | $3,174.28 | $8,572.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,528.37 / $4,213.93 / $7,163.91
| Facility | | $2,528.37 | $4,213.93 | $7,163.91 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |