- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,600.52 / $5,693.00 / $11,100.08
| Facility | | $4,600.52 | $5,693.00 | $11,100.08 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,330.58 / $2,292.89 / $3,896.64
| Professional | | $1,330.58 | $2,292.89 | $3,896.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,423.21 / $4,051.63 / $14,396.24
| Facility | | $2,423.21 | $4,051.63 | $14,396.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,428.00 / $4,014.91 / $5,383.60
| Facility | | $2,428.00 | $4,014.91 | $5,383.60 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,379.00 / $10,950.43 / $15,192.34
| Facility | | $7,379.00 | $10,950.43 | $15,192.34 |