- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,917.20 / $9,248.33 / $19,276.96
| Facility | | $4,917.20 | $9,248.33 | $19,276.96 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,112.00 / $1,556.10 / $11,100.08
| Professional | | $1,112.00 | $1,556.10 | $11,100.08 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,092.34 / $8,013.10 / $15,499.92
| Facility | | $6,092.34 | $8,013.10 | $15,499.92 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $9,496.00 / $10,270.45 / $15,622.00
| Facility | | $9,496.00 | $10,270.45 | $15,622.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,148.00 / $10,270.45 / $14,019.63
| Facility | | $8,148.00 | $10,270.45 | $14,019.63 |