- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,693.00 / $5,549.00 / $7,943.37
| Facility | | $4,693.00 | $5,549.00 | $7,943.37 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,257.35 / $2,081.26 / $5,639.25
| Professional | | $1,257.35 | $2,081.26 | $5,639.25 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,866.60 / $3,325.20 / $14,741.07
| Facility | | $1,866.60 | $3,325.20 | $14,741.07 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,385.67 / $3,006.52 / $3,891.18
| Facility | | $2,385.67 | $3,006.52 | $3,891.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |