- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,012.00 / $6,298.62 / $10,255.42
| Facility | | $5,012.00 | $6,298.62 | $10,255.42 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $1,152.52 / $1,284.29 / $3,156.78
| Professional | | $1,152.52 | $1,284.29 | $3,156.78 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,310.00 / $2,440.15 / $8,689.00
| Facility | | $1,310.00 | $2,440.15 | $8,689.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,626.01 / $2,020.85 / $3,123.82
| Facility | | $1,626.01 | $2,020.85 | $3,123.82 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $8,220.00 / $9,259.00 / $14,242.22
| Facility | | $8,220.00 | $9,259.00 | $14,242.22 |