- 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
- $8,165.50 / $10,739.86 / $20,774.36
| Facility | | $8,165.50 | $10,739.86 | $20,774.36 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,163.00 / $9,696.00 / $18,892.68
| Facility | | $8,163.00 | $9,696.00 | $18,892.68 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $11,630.04 / $13,060.46 / $18,220.40
| Facility | | $11,630.04 | $13,060.46 | $18,220.40 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,777.00 / $8,220.00 / $9,696.00
| Facility | | $6,777.00 | $8,220.00 | $9,696.00 |