- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,119.04 / $11,611.47
| Facility | | $5,091.00 | $7,119.04 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,342.50 / $2,180.00 / $4,822.84
| Professional | | $1,342.50 | $2,180.00 | $4,822.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,756.91 / $2,796.13 / $4,663.00
| Facility | | $1,756.91 | $2,796.13 | $4,663.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,226.01 / $3,271.46 / $4,386.97
| Facility | | $2,226.01 | $3,271.46 | $4,386.97 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,321.00 / $5,847.00 / $7,856.00
| Facility | | $1,321.00 | $5,847.00 | $7,856.00 |