- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,393.00 / $5,549.00 / $10,506.16
| Facility | | $4,393.00 | $5,549.00 | $10,506.16 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,286.31 / $1,738.78 / $2,979.42
| Professional | | $1,286.31 | $1,738.78 | $2,979.42 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,609.51 / $3,627.84 / $9,684.52
| Facility | | $1,609.51 | $3,627.84 | $9,684.52 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,035.72 / $2,900.22 / $3,729.54
| Facility | | $2,035.72 | $2,900.22 | $3,729.54 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,341.00 / $6,588.00 / $10,320.00
| Facility | | $5,341.00 | $6,588.00 | $10,320.00 |