- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $5,091.00 / $7,090.00 / $11,611.47
| Facility | | $5,091.00 | $7,090.00 | $11,611.47 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $650.50 / $1,056.02 / $2,680.01
| Professional | | $650.50 | $1,056.02 | $2,680.01 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,139.53 / $1,826.10 / $7,123.00
| Facility | | $1,139.53 | $1,826.10 | $7,123.00 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,336.00 / $1,896.49 / $2,571.84
| Facility | | $1,336.00 | $1,896.49 | $2,571.84 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $3,711.00 / $5,854.53 / $7,407.10
| Facility | | $3,711.00 | $5,854.53 | $7,407.10 |