- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,964.00 / $6,960.00 / $11,611.47
| Facility | | $4,964.00 | $6,960.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,262.15 / $1,778.48 / $4,362.26
| Professional | | $1,262.15 | $1,778.48 | $4,362.26 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,932.00 / $3,943.73 / $34,774.18
| Facility | | $1,932.00 | $3,943.73 | $34,774.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,158.02 / $4,241.78 / $22,602.68
| Facility | | $2,158.02 | $4,241.78 | $22,602.68 |
- 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 |