- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $6,611.00 / $11,611.47
| Facility | | $5,091.00 | $6,611.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,206.29 / $2,091.94 / $3,559.28
| Professional | | $1,206.29 | $2,091.94 | $3,559.28 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,245.40 / $3,731.39 / $14,396.24
| Facility | | $2,245.40 | $3,731.39 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,209.00 / $3,727.11 / $5,383.60
| Facility | | $2,209.00 | $3,727.11 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,523.00 / $11,869.99
| Facility | | $7,221.00 | $8,523.00 | $11,869.99 |