- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $11,100.08 / $20,928.72
| Facility | | $5,463.36 | $11,100.08 | $20,928.72 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $1,556.10 / $12,765.09
| Professional | | $1,161.00 | $1,556.10 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,064.08 / $4,152.62 / $7,795.52
| Facility | | $3,064.08 | $4,152.62 | $7,795.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,678.00 / $4,406.00 / $13,909.00
| Facility | | $3,678.00 | $4,406.00 | $13,909.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,054.00 / $4,317.00 / $13,909.00
| Facility | | $3,054.00 | $4,317.00 | $13,909.00 |