- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $945.20 / $1,605.54 / $3,829.35
| Professional | | $945.20 | $1,605.54 | $3,829.35 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,468.78 / $2,345.34 / $8,604.00
| Facility | | $1,468.78 | $2,345.34 | $8,604.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,848.64 / $2,300.92 / $3,009.45
| Facility | | $1,848.64 | $2,300.92 | $3,009.45 |
- 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 |