- 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
- $1,204.76 / $1,942.29 / $3,713.53
| Professional | | $1,204.76 | $1,942.29 | $3,713.53 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,324.26 / $3,472.07 / $14,642.40
| Facility | | $2,324.26 | $3,472.07 | $14,642.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,915.54 / $2,987.68 / $3,302.73
| Facility | | $1,915.54 | $2,987.68 | $3,302.73 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,234.00 / $11,555.00 / $14,242.22
| Facility | | $7,234.00 | $11,555.00 | $14,242.22 |