- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,906.00 / $4,235.59 / $7,119.04
| Facility | | $2,906.00 | $4,235.59 | $7,119.04 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,055.91 / $1,611.42 / $4,006.78
| Professional | | $1,055.91 | $1,611.42 | $4,006.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,197.54 / $2,796.89 / $18,644.62
| Facility | | $1,197.54 | $2,796.89 | $18,644.62 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,789.61 / $2,803.76 / $16,446.53
| Facility | | $1,789.61 | $2,803.76 | $16,446.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |