- 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
- $1,354.54 / $1,828.84 / $3,735.80
| Professional | | $1,354.54 | $1,828.84 | $3,735.80 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,819.49 / $3,831.50 / $9,874.90
| Facility | | $1,819.49 | $3,831.50 | $9,874.90 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,151.42 / $2,856.67 / $3,824.77
| Facility | | $2,151.42 | $2,856.67 | $3,824.77 |
- 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 |