- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.20 / $9,248.33 / $19,276.96
| Facility | | $4,917.20 | $9,248.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,435.08 / $1,556.10 / $4,987.33
| Professional | | $1,435.08 | $1,556.10 | $4,987.33 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,896.29 / $5,280.48 / $9,912.79
| Facility | | $3,896.29 | $5,280.48 | $9,912.79 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,064.00 / $9,719.69
| Facility | | $7,221.00 | $8,064.00 | $9,719.69 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,178.00 / $7,441.00 / $8,816.00
| Facility | | $6,178.00 | $7,441.00 | $8,816.00 |