- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,119.04 / $12,765.09
| Facility | | $5,091.00 | $7,119.04 | $12,765.09 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,208.11 / $2,111.21 / $3,623.30
| Professional | | $1,208.11 | $2,111.21 | $3,623.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,120.46 / $3,504.49 / $23,351.66
| Facility | | $2,120.46 | $3,504.49 | $23,351.66 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,243.00 / $3,940.45 / $8,854.25
| Facility | | $2,243.00 | $3,940.45 | $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 |