- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,463.36 / $10,975.77 / $22,021.17
| Facility | | $5,463.36 | $10,975.77 | $22,021.17 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,161.00 / $9,185.68 / $12,765.09
| Professional | | $1,161.00 | $9,185.68 | $12,765.09 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,732.29 / $13,189.77 / $24,760.56
| Facility | | $9,732.29 | $13,189.77 | $24,760.56 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,217.00 / $7,934.00 / $15,405.17
| Facility | | $4,217.00 | $7,934.00 | $15,405.17 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,169.55 / $8,180.98 / $11,232.30
| Facility | | $7,169.55 | $8,180.98 | $11,232.30 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,356.00 / $7,772.00
| Facility | | $3,711.00 | $5,356.00 | $7,772.00 |