- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,090.00 / $11,611.47
| Facility | | $5,091.00 | $7,090.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $895.61 / $1,408.11 / $2,913.06
| Professional | | $895.61 | $1,408.11 | $2,913.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,446.28 / $2,351.19 / $20,063.05
| Facility | | $1,446.28 | $2,351.19 | $20,063.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,807.00 / $2,336.39 / $16,721.23
| Facility | | $1,807.00 | $2,336.39 | $16,721.23 |
- 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 |