- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,298.62 / $11,100.08
| Facility | | $4,964.00 | $6,298.62 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,277.25 / $2,254.05 / $4,349.50
| Professional | | $1,277.25 | $2,254.05 | $4,349.50 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,013.41 / $3,649.81 / $25,336.55
| Facility | | $2,013.41 | $3,649.81 | $25,336.55 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,436.00 / $4,214.10 / $8,854.25
| Facility | | $2,436.00 | $4,214.10 | $8,854.25 |
- 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 |