- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $4,146.00 / $5,091.00 / $7,120.36
| Facility | | $4,146.00 | $5,091.00 | $7,120.36 |
- Facility/Professional
- Professional
- Modifier
- Low / Median / High Price
- $977.18 / $2,093.98 / $4,009.77
| Professional | | $977.18 | $2,093.98 | $4,009.77 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $1,682.65 / $2,908.31 / $8,572.06
| Facility | | $1,682.65 | $2,908.31 | $8,572.06 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $2,275.83 / $3,860.24 / $6,824.24
| Facility | | $2,275.83 | $3,860.24 | $6,824.24 |
- Facility/Professional
- Facility
- Modifier
- Low / Median / High Price
- $7,221.00 / $8,060.00 / $11,869.99
| Facility | | $7,221.00 | $8,060.00 | $11,869.99 |