- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,277.00 / $5,463.36 / $10,506.16
| Facility | | $4,277.00 | $5,463.36 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,241.85 / $1,828.01 / $2,937.01
| Professional | | $1,241.85 | $1,828.01 | $2,937.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,433.92 / $2,333.37 / $5,847.00
| Facility | | $1,433.92 | $2,333.37 | $5,847.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,798.85 / $2,283.08 / $2,995.39
| Facility | | $1,798.85 | $2,283.08 | $2,995.39 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,126.00 / $5,854.53 / $7,305.00
| Facility | | $2,126.00 | $5,854.53 | $7,305.00 |