- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $9,148.54 / $11,923.23
| Facility | | $5,091.00 | $9,148.54 | $11,923.23 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $419.62 / $3,491.35 / $5,720.16
| Professional | | $419.62 | $3,491.35 | $5,720.16 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,078.26 / $8,627.00 / $15,086.34
| Facility | | $1,078.26 | $8,627.00 | $15,086.34 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,092.94 / $9,087.54 / $12,533.51
| Facility | | $1,092.94 | $9,087.54 | $12,533.51 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,346.00 / $14,242.22
| Facility | | $8,220.00 | $9,346.00 | $14,242.22 |