- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,365.16 / $7,079.46 / $11,481.54
| Facility | | $4,365.16 | $7,079.46 | $11,481.54 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $4,570.88 / $7,413.10 / $11,220.18
| Professional | | $4,570.88 | $7,413.10 | $11,220.18 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,238.72 / $5,888.44 / $12,022.64
| Facility | | $2,238.72 | $5,888.44 | $12,022.64 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $6,025.60 / $12,589.25 / $18,197.01
| Facility | | $6,025.60 | $12,589.25 | $18,197.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,290.87 / $9,120.11 / $19,498.45
| Facility | | $2,290.87 | $9,120.11 | $19,498.45 |