- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,297.31 / $2,126.36 / $4,363.54
| Professional | | $1,297.31 | $2,126.36 | $4,363.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,317.42 / $3,807.62 / $14,396.24
| Facility | | $2,317.42 | $3,807.62 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,293.00 / $3,951.27 / $5,383.60
| Facility | | $2,293.00 | $3,951.27 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,379.00 / $10,950.43 / $15,192.34
| Facility | | $7,379.00 | $10,950.43 | $15,192.34 |