- 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
- $1,034.16 / $1,649.36 / $4,695.32
| Professional | | $1,034.16 | $1,649.36 | $4,695.32 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,754.50 / $2,738.31 / $20,063.05
| Facility | | $1,754.50 | $2,738.31 | $20,063.05 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,027.00 / $2,738.31 / $14,856.44
| Facility | | $2,027.00 | $2,738.31 | $14,856.44 |
- 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 |